OUTCOMES OF SEVERELY ABNORMAL UMBILICAL ARTERY DOPPLER VELOCIMETRY INSTRUCTURALLY NORMAL SINGLETON FETUSES

Objective: To construct a management guide for preterm pregnancies com plicated by severely abnormal umbilical artery Doppler velocimetry. Me thods: A retrospective chart review was conducted on all cases of abse nt or reversed end-diastolic flow umbilical artery Doppler velocimetry identified through an ultrasound data base. Maternal and perinatal ou tcome variables were retrospectively reviewed and analyzed using both parametric and nonparametric statistical techniques. Seventy-one cases were identified over a 5-year period. After excluding multiple gestat ions, anomalous fetuses, and two cases that were terminated before 24 weeks' gestation, 56 singleton gestations remained for analysis. Resul ts: Among the 56 subjects, there were 45 survivors and 11 deaths (five fetal and six neonatal deaths). Nonsurvivors had a significantly lowe r gestational age at diagnosis and delivery. Nonsurviving live-born ne onates had lower Apgar scores and were significantly smaller; however, there were no differences in proportion or severity of fetal growth r estriction in survivors and nonsurvivors. There were no differences in last biophysical profile before delivery or interval from diagnosis o f reversed end-diastolic flow to delivery. Predictors of nonsurvival w ere the presence of reversed end-diastolic flow and oligohydramnios. P erinatal mortality for reversed end-diastolic flow was 333/1000 and 94 /1000 for absent end-diastolic flow. Risk or perinatal death was highl y gestational age dependent. For delivery at less than 26 weeks, survi val was one of four; at 26-27.9 weeks, survival was seven of 12; and a t 28 weeks or greater, survival was 37 of 40. Conclusion: Whereas seve rely abnormal umbilical artery blood now poses significant risk for pr egnancy, perinatal mortality is dominated by gestational age at diagno sis and delivery. This may reflect the severity of the disease or the low survival of very immature gestations. Interventions on behalf of t he fetus at very early gestational ages should be undertaken with caut ion.