END-DIASTOLIC ZERO FLOW OF THE FETAL AORT A AND OBSTETRICAL MANAGEMENT

An enddiastolic zero flow of the fetal aorta is one of the most import ant anomalies to be detected by fetal Doppler sonography. Subsequent b irth management is controversial. At our clinic, 33 pregnancies (total of 33 fetuses) with this type of pathology in the Doppler ultrasound (US) were analysed. CTG was performed directly after the US examinatio n, the birth management being decided upon according to CTG findings. Mean pregnancy duration at diagnosis was 30 + 1 weeks (23 + 5 - 37 + 6 ). All 33 fetuses showed an extensive retardation up to 4 weeks below the 50(th) percentile of the calculated week of pregnancy. An average period of 3 days (0 - 21) elapsed between diagnosis of zero flow of th e fetal aorta and delivery. Caesarean section (CS) was performed in 27 /33 (85%) of patients. The indication for all CSs was a pathological C TC. Only 5 children were delivered vaginally. All children were follow ed up. Only 6 had to be intubated primarily. The mean 5 min. apgar sco re of all other children was 8. Two groups were differentiated in the total study collective. In group I (n = 9) children were delivered due to a pathological CTG on the day of fetal zero flow diagnosis. Delive ry in group II (n = 24) was performed one to several days after diagno sis of fetal zero flow and subsequent pathological CTG. The difference in the arterial umbilical cord pH between the two groups was signific ant (p = 0.0168): Group I 7.10 and Group II 7.22. Our findings show th at fetal condition monitored closely by CTC clearly deteriorates withi n a mean of 3 days after diagnosis of a pathological flow in the fetal aorta. A CS at the time of the first pathological CTG, not at the tim e of Doppler US diagnosis, is in our opinion the optimal obstetric man agement of these fetuses at high risk, since important time can thereb y be gained, eg. for pulmonal maturation.