THE CLINICAL-VALUE OF UMBILICAL ARTERY DOPPLER VELOCIMETRY IN THE MANAGEMENT OF INTRAUTERINE GROWTH-RETARDED FETUSES BEFORE 32 WEEKS GESTATION

The objective of this study was to investigate the clinical utility of umbilical artery Doppler velocimetry in the management of very premat ure growth-retarded fetuses. The study comprised 34 fetuses between 26 and 34 weeks' gestation, diagnosed ultrasonically as suffering from i ntrauterine growth retardation. Based on the umbilical artery Doppler findings, patients were divided into 3 groups: group 1 (10 fetuses) wi th normal Doppler systolic/diastolic (S/D) ratios (within 2 SD of the mean for gestational age); group 2 (9 fetuses) with significant abnorm al umbilical artery S/D ratios (above 2 SD of the mean for gestational age), and group 3 (15 fetuses) with absent or reverse end-diastolic f low. Fetal outcome was assessed in terms of neonatal mortality and mor bidity, i.e. low umbilical artery pH (pH < 7.20) and Apgar scores. In group 1, all fetuses had a stable, normal S/D ratio; in group 2, 2 fet uses (22%) showed deterioration in the Doppler findings and were trans ferred to group 3, while in group 3, 3 of 15 fetuses (20%) showed impr ovement in the absence of end-diastolic flow and were thus transferred to group 2. Emergency cesarean section due to antenatal deterioration of the biophysical profile occurred in only 1 patient (10%) in group 1, compared to 33 and 87% in groups 2 and 3, respectively (p < 0.05). The other 9 patients in group 1 had normal vaginal deliveries at 36-37 weeks' gestation, with no perinatal complications. The mean expectant interval from admission to delivery in group 3 was 8.2 days, while in groups 1 and 2 it was 23.8 and 22.2, respectively (p < 0.01). Four ca ses of perinatal mortality appeared among fetuses in group 3 only, and the morbidity in this group was higher than those of the other groups . Our study showed that umbilical artery Doppler velocimetry in very p remature growth-retarded fetuses allows early recognition of those who will become compromised perinatally. Furthermore, it helps to identif y the growth-retarded fetus with adequate placental circulation, there by allowing ambulatory follow-up.