FETAL UMBILICAL DOPPLER IN A POPULATION OF 541 HIGH-RISK PREGNANCIES - PREDICTION OF PERINATAL-MORTALITY AND MORBIDITY

Objective: To evaluate the usefulness of systematic umbilical Doppler in the assessment of high-risk pregnancies. Method: In a prospective m ulticentre study, a group of high-risk pregnancies (intrauterine growt h retardation, hypertension during pregnancy, abnormal obstetric histo ry) was systematically studied by Doppler exploration of the fetal umb ilical artery between 28 and 34 weeks. All the details of pregnancy de velopment to the first postnatal days were collected and analysed a po steriori. Results: Three groups were formed according to Doppler resul ts (Index S-D/S) A, index < 90th percentile (n = 458, 84.6%); B, index greater than or equal to 90th percentile and diastole over zero (n = 67, 12.4%); C, zero diastole (n = 16, 2.9%). There was a strong correl ation between Doppler results and pregnancy development. Group C corre sponded to a greatly altered prognosis (hypotrophy, <3rd percentile in 69%; intrauterine deaths in 9/16). In group B, relative to group A, t he prognosis was significantly altered (hypotrophy, 24% versus 6%, P < 0.01; prematurity rate, 25% versus 11%, P < 0.001) but these repercus sions were not as severe as in group C. Conclusion: In high-risk pregn ancies, fetal umbilical artery Doppler study is of interest for progno stic assessment. Normal results should provide temporary reassurance. Abnormal umbilical Doppler indicates that chronic suffering will occur or is onset in at least one-third of cases.