Erste klinische Erfahrungen mit der Dopplersonographie venöser fetaler Gefäße in Hochrisiko-Schwangerschaften mit Reverse-Flow in der A. umbilicalis

Abstract

This observational study reports on the changes in blood flow waveforms recorded from the ductus venosus (DV) and the umbilical vein (UV) in six high-risk pregnancies presenting with reverse flow in the umbilical artery. Five fetuses were growth-retarded (IUGR), and one fetus had congenital heart disease. Results: Three fetuses (27, 33 and 36 weeks) with IUGR, reverse end-diastolic velocities in the DV and UV pulsations died in the perinatal period. In two of these fetuses, typical signs of heart decompensation (mild pleural effusion and/or ascites) could also be visualised by B-mode sonography. Two other growth-retarded fetuses (28 and 29 weeks) and the infant with truncus arteriosus communis (37 weeks), showed end-diastolic forward flow in the venous vessels; all of them survived. Conclusions: End-diastolic reverse flow in the DV and UV pulsations indicate right heart failure as the terminal stage of placental dysfunction. In special cases, venous Doppler sonography may assist in managing pregnancies with compromised fetuses showing pathological arterial blood flow waveforms.