VENOUS DOPPLER IN THE FETUS WITH ABSENT END-DIASTOLIC FLOW IN THE UMBILICAL ARTERY

High perinatal mortality has been reported in association with the fin ding of absent end-diastolic pow velocities in the umbilical artery. T he fetus is known to centralize its circulation during hypoxemia and a bnormal venous blood flow velocities have been reported in cases of he art failure and imminent asphyxia. The aim of this study was to evalua te blood pow velocities recorded with Doppler ultrasound in the umbili cal vein, inferior vena cava and middle cerebral artery as predictors of survival in 17 fetuses with absent or reversed end-diastolic flow i n the umbilical artery. There were five perinatal deaths, all having a bnormal umbilical cord venous pulsations. An increased proportion of d iastolic blood flow velocity in the middle cerebral artery as a sign o f hypoxia was found in 12 fetuses without a relationship to perinatal mortality. An increased proportion of retrograde blood pow in the infe rior vena cava was recorded in only one fetus, which died on the same day of congestive heart failure, suggesting fetal heart sparing in the remaining complicated pregnancies. The results suggest that abnormal end-diastolic umbilical venous pulsation in the cord is a late and omi nous sign of a severely compromised fetus, while abnormal blood flow v elocimetry in the middle cerebral artery might be an earlier sign of f etal hypoxia, with a better prognosis.