Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction

Objective The aim of this investigation was to assess the relationship betw een abnormal arterial and venous Doppler findings and perinatal outcome in fetuses with intrauterine growth restriction (IUGR). Methods Doppler velocimetry of the umbilical artery (UA), middle cerebral a rtery (MCA), inferior vena cava (IVC), ductus venosus (DV) and free umbilic al vein was performed in 121 IUGR fetuses with a UA pulsatility index (PI)> 2SD above the gestational age mean and subsequent birth weight ( 10th centi le for gestational age. Groups based on the last Doppler exam were: 1 = abn ormal UA-PI only (n=42, 34.7%), 2=MCA-PI > 2SD below the gestational age me an (= 'brain sparing') in addition to abnormal UA-PI (n = 29, 24.0%), 3 = D V or IVC peak velocity index (PVIV) > 2SD above the gestational age mean an d/or pulsatile UV flow in = 50, 41.3%). Z-scores (delta indices) were calcu lated for Doppler indices. Perinatal mortality, respiratory distress (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necro tizing enterocolitis (NEC), circulatory failure and umbilical artery blood gases were recorded. Results Absence or reversal of umbilical artery end-diastolic flow was obse rved in 4 (9.5%) of fetuses in group 1, 10 (34.5%) fetuses in group 2 and 4 1 (82%) fetuses in group 3. A low middle cerebral artery Pulsatility index was found in 39 (78%) fetuses in group 3. Multiple regression analysis with gestational age at delivery, delta indices and cord artery blood gas as in dependent para meters and individual perinatal outcomes as dependent variab les was performed. In this analysis the association was strongest with gest ational age for each complication. There were no significant differences in Apgar scores between groups. At delivery, 'brain sparing' was associated w ith hypoxemia and abnormal venous flows with acidemia. Perinatal mortality was highest in group 3 and stillbirth was only observed when venous flow wa s abnormal. All postpartum complications were more frequent in fetuses with abnormal venous flows. The only statistically significant relation between Doppler indices and outcome was the association between abnormal ductus ve nosus flow and fetal death (r(2) = 0.24, P < 0.05). Conclusion Growth restricted fetuses with abnormal venous flow have worse p erinatal outcome compared to those where flow abnormality is confined to th e umbilical or middle cerebral artery In fetuses with low middle cerebral a rtery pulsatility, venous Doppler allows detection of further deterioration . while abnormal venous flows can be significantly associated with fetal de mise, gestational age at delivery significantly impacts on all short-term o utcomes.