Abstract
PROGRESSES IN THREE CHARACTERISTIC PATTERNS OZHAN TURAN, SIFA TURAN, CHRISTOPH BERG, ULRICH GEMBRUCH, KYPROS NICOLAIDES, CHRISTOPHER HARMAN, AHMET BASCHAT, University of Maryland at Baltimore, Baltimore, Maryland, University of Maryland, Baltimore, Baltimore, Maryland, Friedrich Wilhelm University, Bonn, Obstetrics & Prenatal Medicine, Bonn, Germany, Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom OBJECTIVE: To identify the temporal sequence of arterial and venous Doppler abnormalities from the onset of placental insufficiency until delivery in FGR. STUDY DESIGN: Singleton FGR (abdominal circumference 5th %ile) were studied prospectively, with umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) Doppler. Time intervals between progressive Doppler abnormalities and the sequence of Doppler changes defined characteristic patterns. RESULTS: 688 longitudinal exams were performed in 104 fetuses identifying 3 patterns of progression. I.Mild placental dysfunction (n 34): abnormality was confined to the UA/MCA. UA normal until 32 weeks (w, median) but never escalated 3 SD. Progression took 33 days requiring delivery at 35 w. II.Progressive placental dysfunction (n 49): In 9 day intervals, normal UA Doppler (29 w) increased 3 SD, followed by onset of abnormal MCA, UA diastolic flow absent/ reversed, abnormal venous Doppler requiring delivery by 33 w. III.Severe early placental dysfunction (n 21). UA Doppler markedly elevated by 27 w with rapid progression (7 day interval) to abnormal venous Doppler with delivery at 30 w. Gestational age at onset, time to delivery and progression intervals were significantly different between patterns (p 0.05 for all).
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