F55Venous velocimetry in the surveillance of severely compromised fetuses. Where is the point of no return?

Abstract

ObjectiveTo investigate special changes in venous velocimetry of severely compromised fetuses and to determine signs of cardiac decompensation prior fetal demise.MethodsA prospective study in 154 growth‐restricted fetuses. 37 were severely compromised with reverse flow in the umbilical artery. The velocimetry of right hepatic vein and ductus venosus were investigated and the presence of umbilical venous pulsations were registered. The final examination prior to birth or fetal demise were taken for analysis and related to obstetrical outcome defined as gestational age at birth, birthweight and rate of perinatal mortality. Secondly the velocimetry of 15 nonsurvivors was pared with 22 survivors.ResultsThere were a significant (P < 0.05) decrease of the S‐ and ES‐, increase of the A‐velocity and pulsatility in the RHV and a significant (P < 0.05) decrease of all velocities and increase of pulsatility in DV. 24% had a reversed flow in DV and 75% had pulsations. The newborn were significantly premature and small for gestational age. 15 fetuses died perinatally. Special predictors of fetal demise were a further increase or decrease of A‐velocity in RHV and DV. 8/15 fetuses had a reversed flow in DV and 11/1 5 had mainly double pulsations as signs of cardiac decompensation.ConclusionsVenous velocimetry changes significantly in compromised fetuses. Prior to fetal demise the A‐velocity decreases specifically in DV. Especially a reversed flow in DV and double umbilical venous pulsations are omnious signs of left heart decompensation.