DOPPLER IN NONIMMUNE HYDROPS-FETALIS

Fetal ultrasound studies were performed on 24 fetuses with non-immune hydrops to evaluate echocardiographic and cardiovascular Doppler param eters that may be useful in assessing hemodynamics and in predicting o utcome. Of all cardiovascular parameters analyzed, only the presence o f abnormal pulsations in the umbilical vein (p < 0.001) was found to b e significantly different between the 11 survivors and 13 non-survivor s. In a smaller subset of 12 fetuses, in whom inferior vena caval wave forms were recorded, survivors (n = 6) had a significantly lower perce ntage of retrograde flow in the inferior vena cava (p < 0.001) and hig her inferior vena caval E/V velocity ratio (p < 0.001) than non-surviv ors (n = 6). Sixteen of the 24 cases examined had abnormal umbilical v enous pulsations; 12 of the 16 (75%) died including all fetuses with h ydrops due to twin-to-twin transfusion or congenital heart disease. Wh en fetuses with pulsatile flow in the umbilical vein were compared wit h fetuses with normal umbilical venous flow, the following significant differences were found: lower right and left ventricular output veloc ities, larger inferior vena caval diameter, decreased shortening fract ions of the right and left ventricles, and lower peak velocities at th e aortic and pulmonary valves and in the ductus arteriosus.