Ductus venosus Doppler and postnatal outcomes in fetuses with absent or reversed end-diastolic flow in the umbilical arteries

Abstract 

Objective

To evaluate the relationship between ductus venosus Doppler findings on the day of delivery and postnatal outcomes in pregnancies with absent or reversed end-diastolic (ARED) flow in the umbilical arteries.

Study design

Postnatal outcomes of 103 newborns of pregnancies with a diagnosis of ARED flow on Doppler velocimetry of the umbilical arteries were analyzed retrospectively between January 1997 and December 2004. Single pregnancies and fetuses without malformations were included. The cases were divided into two groups according to the flow during atrial contraction (a-wave) in the ductus venosus on the day of delivery: group A, 20 cases with absent or reversed flow in the ductus venosus and group B, 83 cases with positive flow. The results were analyzed statistically using the chi-square test, Fisher's exact test and the Mann-Whitney U test with the level of significance set at 5%.

Results

All newborns were delivered by cesarean section. Gestational age was similar in the two groups (group A: 30 weeks and group B: 30.9 weeks, P=0.23). Absent or reversed ductus venosus flow was associated with the following adverse postnatal outcomes: lower birthweight (P<0.001), lower Apgar scores in the first (P=0.001) and fifth minute (P=0.001), a higher frequency of orotracheal intubation (P=0.001) and pH at birth less than 7.20 (P<0.001), pulmonary hemorrhage (P=0.03), thrombocytopenia (P=0.02), hypoglycemia (P=0.01), intracranial hemorrhage (P=0.02), and postnatal death (P=0.007).

Conclusion

The study of ductus venosus flow may provide additional information regarding the best time for interruption of pregnancies with ARED flow in the umbilical arteries characterized by extreme prematurity.

Keywords: Ductus venosus, Absent or reversed end-diastolic velocity, Neonatal results, Adverse neonatal outcomes