Fetal Doppler Evaluation and Perinatal Outcomes in the Absence of Fetal Growth Restriction [8R

Abstract

INTRODUCTION: Antepartum fetal surveillance techniques are used to assess fetal well-being in pregnancies complicated by preexisting maternal conditions, and pregnancies in which complications develop (1). The application of Doppler velocimetry to antepartum fetal assessment allows for evaluation of placental status and helps to determine the relative risk of sudden fetal deterioration (2). The purpose of this study is to determine whether patients with hypertension or preeclampsia and normally grown fetuses yet abnormal Doppler studies are at an increased risk for adverse perinatal outcomes. METHODS: This is a retrospective review of 287 high-risk pregnancies with appropriate-for-gestational- age (AGA) fetuses who had ultrasound evaluations between January 2012 and December 2013. Ultrasound evaluation included fetal growth assessments every four weeks with umbilical artery (UA) and middle cerebral artery (MCA) Doppler interrogation. The control group always had normal Dopplers. The study group had at least one abnormal UA Doppler or one abnormal MCA Doppler. Perinatal outcomes were compared between the groups. RESULTS: Of the 287 high-risk AGA pregnancies evaluated, 12.5% (n=36) had at least one abnormal UA or MCA Doppler. Pregnancies complicated by hypertension or preeclampsia had a statistically significant increased risk of having an abnormal UA and/or MCA Doppler (p=0.0013 and p=0.0086, respectively), and were significantly more likely to deliver preterm (p=0.0066 and p=0.0001, respectively). CONCLUSION: Fetoplacental circulation may be altered in preeclamptic and hypertensive patients, yet the fetus may not be growth restricted. Abnormal umbilical and middle cerebral artery Dopplers in AGA pregnancies may identify those fetuses that are at risk for preterm delivery.