OBJECTIVE: The purpose of this retrospective analysis was to compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery Doppler flow and the outcomes of pregnancies with end-diastolic velocity either diminished or severely reduced/absent. METHODS: One hundred pregnant women with growth-restricted fetuses were followed with Doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal Doppler group (16%), the less-severely abnormal group (77%), and the group with severely reduced or absent end-diastolic velocity waveforms (7%). RESULTS: The diagnosis-to-delivery interval was significantly shorter, and the average birth weight and gestational age at delivery were significantly lower, for fetuses with abnormal Doppler velocimetry (showing diminished or severely reduced/absent end-diastolic velocity) than for those in the normal Doppler group. Fetuses with abnormal Doppler velocimetry also had a significantly higher incidence of oligohydramnios, low-birth weight (<10th percentile), and admission to the Neonatal Intensive Care Unit. There were no perinatal deaths among the normal Doppler patients. CONCLUSIONS: Growth-restricted fetuses with normal umbilical artery velocimetry are at significantly lower risk than those with abnormal velocity waveforms, and immediate delivery of the fetus with diminished end-diastolic flow may be unnecessary. Knowing this relationship may be useful in the clinical management of such pregnancies. Doppler surveillance of growth-restricted fetuses supplemented with cardiotocography, preferably combined with biophysical profile testing, results in a prolonged gestational age and acceptable fetal outcome.
OBJECTIVE: The purpose of this retrospective analysis was to compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery Doppler flow and the outcomes of pregnancies with end-diastolic velocity either diminished or severely reduced/absent. METHODS: One hundred pregnant women with growth-restricted fetuses were followed with Doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal Doppler group (16%), the less-severely abnormal group (77%), and the group with severely reduced or absent end-diastolic velocity waveforms (7%). RESULTS: The diagnosis-to-delivery interval was significantly shorter, and the average birth weight and gestational age at delivery were significantly lower, for fetuses with abnormal Doppler velocimetry (showing diminished or severely reduced/absent end-diastolic velocity) than for those in the normal Doppler group. Fetuses with abnormal Doppler velocimetry also had a significantly higher incidence of oligohydramnios, low-birth weight (<10th percentile), and admission to the Neonatal Intensive Care Unit. There were no perinatal deaths among the normal Doppler patients. CONCLUSIONS: Growth-restricted fetuses with normal umbilical artery velocimetry are at significantly lower risk than those with abnormal velocity waveforms, and immediate delivery of the fetus with diminished end-diastolic flow may be unnecessary. Knowing this relationship may be useful in the clinical management of such pregnancies. Doppler surveillance of growth-restricted fetuses supplemented with cardiotocography, preferably combined with biophysical profile testing, results in a prolonged gestational age and acceptable fetal outcome.