Outcome of 88 pregnancies with absent or reversed end-diastolic blood flow (ARED flow) in the umbilical arteries

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Abstract

Objectives: to investigate both perinatal and postneonatal morbidity and mortality in fetuses with absent or reversed end-diastolic flow (ARED flow) in the umbilical artery. Study design: A 5 year prospective follow-up of 88 fetuses with ARED flow. Results: Sixteen stillbirths, 16 neonatal deaths, six postneonatal deaths and one death at 2 years of age were noted. Out of the 42 fetuses born alive, 36 showed a normal neurological development whereas six were mentally handicapped. Adverse prognosis was more frequently found in the group with absent end-diastolic flow at first examination and then reversed flow until delivery, compared to the groups of always absent or always reversed end-diastolic flows. Conclusions: Prompt delivery is recommended in these high-risk pregnancies in order to prevent long-term sequelae, obviously depending on the local limits of viability. Further studies appropriately designed for assessing long-term neurodevelopment of fetuses with ARED flow, although demanding, are mandatory.

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].

Section snippets

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.

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