Relationship between fetal cardiac and extra-cardiac Doppler flow velocity waveforms and neonatal outcome in intrauterine growth retardation

Abstract

In a total of 42 consecutive pregnancies with intrauterine growth retardation (IUGR), Doppler velocimetry was related to neonatal outcome as determined by Apgar score at 1 min, umbilical artery acid-base status and Po2, number of nucleated red blood cells (NRBC), duration of ventilatory support, and sonographic appearance of cerebral leukomalacia. Doppler flow velocity waveforms were obtained from the ascending aorta (AO), pulmonary artery (PA), internal carotid artery (ICA) and umbilical artery (UA) at 2–3 day intervals until delivery. At cardiac level the peak systolic velocity (PSV) and time-averaged velocity (AV), and at peripheral level the pulsatility index (PI) was determined. As all Doppler parameters were significantly related to gestational age at birth, gestational age was taken into account in the analysis. There was no relationship between Apgar score, acid-base status and Doppler parameters. Low AVAO was related to a low umbilical artery Po2. Significant correlations were established between PSVPA, AVPA and PIUA, and the duration of neonatal ventilatory support. Infants who died within 22 days after admission to the neonatal intensive care unit (n = 7) displayed a significantly higher PIUA than those who remained alive. The PIUA was also related to the absolute and relative number of NRBCs. No relationship existed between the Doppler parameters and degree of leukomalacia. The present study demonstrates that from all Doppler parameters, the PIUA is most clearly related to neonatal outcome in IUGR.