Original scientific paper
A TEMPORAL MODEL OF DOPPLER DETERIORATION IN FETAL GROWTH RESTRICTION RELATED TO CARDIOTOCOGRAPHIC MONITORING
Luis T. Mercé
; International Ruber Hospital, Madrid, Spain
Alfonso Carrasco
; University General Hospital, Alicante, Spain
Juan Carlos Martínez
; University General Hospital, Alicante, Spain
Abstract
Aims. To describe the time sequence of abnormal Doppler changes and its relationship with fetal heart rate (FHR) registrations in growth restricted fetuses. Methods. Fifteen singleton pregnancies with an ultrasound diagnosis of fetal growth restriction (abdominal circumference (AC) <2 SD) were prospectively and longitudinally evaluated. Fetal outcome included four perinatal deaths, seven emergency cesarean sections due to abnormal cardiotocographic (CTG) registers and four admissions in Neonatal Intensive Care Unit (NICU). Results. We observed »early« Doppler changes (15 to 10 days prior to delivery) in umbilical artery (UA), middle cerebral artery (MCA) and cerebral-placental ratio (CPR). »Late« Doppler changes included absent or reverse diastolic flow in umbilical artery, ductus venosus (DV) high resistance and umbilical venous blood flow decrease. These changes appear in a 10% of cases four to seven days prior to delivery and up to the 40% of cases on the same day of delivery. Although less frequently, umbilical vein pulsations, reverse »a« wave at DV and MCA increased flow resistance can also be observed closer to delivery. »Late« Doppler changes ¬appear in 2/3 of cases with »early« Doppler changes and in a 40% of those with an abnormal CTG register. These changes precede one to 10 days the abnormal CTG patterns. All perinatal deaths took place in patients showing »late« Doppler changes (4/10), whereas an abnormal CTG without »late« Doppler changes lead to emergency cesarean delivery because a risk of loss of fetal well-being (7/10). Conclusions. Time sequence and the standard model of Doppler changes in fetal growth restriction were described. It is obviously not a rule for fetal deterioration to take place the same way in any individual affected fetus. Nevertheless, it is apparent that »late« Doppler changes usually precede an abnormal CTG pattern and are associated to a higher perinatal mortality.
Keywords
fetal growth restriction; Doppler; cardiotocography; fetal surveillance
Hrčak ID:
23281
URI
Publication date:
1.3.2007.
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