European Journal of Obstetrics & Gynecology and Reproductive Biology
Outcome of 88 pregnancies with absent or reversed end-diastolic blood flow (ARED flow) in the umbilical arteries
Introduction
Absent and reversed end-diastolic blood flows (ARED flow) in the umbilical arteries, assessed by pulsed Doppler ultrasound, are considered a very ominous sign of placental compromise and are associated with high perinatal mortality rates 1, 2, 3.
These abnormal umbilical blood flow patterns are more often found in high-risk pregnancies, namely those with hypertension or intrauterine growth retardation (IUGR). The latter condition has been associated with a higher prevalence of adult diseases such as stroke and ischemic cardiopathy [2].
Most studies concerning ARED flow assessed birth outcomes using indicators such as Apgar score or umbilical cord blood gases which proved to be relatively unreliable [3].
The heterogeneity of the studied groups is a further explanation for inconsistencies in the follow-up assessment of these fetuses. Moreover, arbitrary definitions of “normal” and “abnormal” outcomes are abusively used and raise difficulties in the validation of this and other antenatal tests.
We analyzed the perinatal outcome and prospectively followed, until the minimum age of 1 year, the survivors of 88 fetuses with ARED blood flow, in order to ascertain morbidity and mortality in this high-risk group [4].
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Material and methods
From January 1990 to December 1995 we recorded at our Ultrasound Unit 89 cases of ARED flow, in which no congenital anomalies, chromosomal disorders or congenital infection were identified.
Doppler examinations were always performed by the same operator (NM), using two commercial available ultrasound machines (Aloka 680 SSD and Aloka 2000 SSD, Japan [5]) and a convex 3.5 or 5 MHz transabdominal probe. The high-pass filter was systematically set at 50 Hz and an angle of less than 30 degrees was
Results
Maternal and fetal characteristics are present in Table 1.
End-diastolic flow was always absent from the first Doppler examination in 66 fetuses (75%) and reversed in 8 fetuses (9.1%). In 14 fetuses (15.9%), the end-diastolic flow was initially absent and then became reversed. Fetal, neonatal and postneonatal mortality were significantly higher in the latter group (78.6% vs. 34.8% in the AED and RED groups, P=0.007).
Out of the 88 fetuses 16 were stillbirths. There were 16 neonatal deaths and six
Discussion
Doppler ultrasound is increasingly used in obstetric decision-making since it is a reliable noninvasive method for assessing fetoplacental haemodynamics.
ARED flows in the umbilical arteries consistently predict pregnancies at increased risk for an ominous fetal outcome, namely in the high-risk preterm fetus 6, 7, 8.
However, studies dealing with long-term follow-up of fetuses with ARED flow beyond the perinatal period are still scantily available in the literature 9, 10, 11, 12.
Our study is
Condensation
A 5 year prospective study of 88 pregnancies with ARED flow was performed to evaluate the perinatal and childhood outcome.
References (19)
- et al.
Clinical significance of absent or reversed end-diastolic velocity waveforms in umbilical artery
Lancet
(1994) - et al.
Placental morphology and absent or reversed end diastolic flow velocities in the umbilical artery: a clinical and morphometrical study
Placenta
(1996) Umbilical artery Doppler velocimetry: clinical utility in high-risk pregnancies
Am J Obstet Gynecol
(1996)- et al.
Intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery is associated with maldevelopment of the placental terminal villous tree
Am J Obstet Gynecol
(1996) - et al.
Growth deficient fetuses with absent or reverse umbilical artery end-diastolic flow are metabolically compromised
Early Hum Dev
(1995) - et al.
Vulnerability of developing brain. Effects of early nutritional deprivation on reflex ontogeny and development of behavior in the rat
Brain Res
(1971) - et al.
Fetal growth and coronary heart disease in South India
Lancet
(1996) - et al.
Absent and reversed end-diastolic flows in the umbilical artery (ARED flow) and placental findings
J. Matern–Fetal Invest
(1997) - Barker DJP. Fetal and infant origins of adult disease. London: British Medical Journal Press,...