OP07.28: The perinatal outcome of 48 IUGR fetuses with ARED

Abstract

Objective: To determine the perinatal outcome of fetuses with absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) Doppler. Methods: Forty-eight IUGR fetuses between 24 and 34 gestational weeks with findings of ARED flow in the UA were prospectively followed. The fetuses monitored by repeat blood flow Doppler measurements of arterial and venous vessels, cardiotocography and biophysical scoring. Maternal evaluation and follow up was also carried out for detection of development of pre-eclampsia. Delivery was planned when nonreassuring findings were detected in any test. Perinatal outcomes were investigated up to the end of the first month of life. Results: The overall survival of the fetuses until the end of neonatal period with ARED was 22.9% (37/48). Intrauterine fetal death was observed in three (6.3%) cases. All the three fetuses which had ARED before 26 weeks were all died in-utero. Of the three fetuses died in utero, two had reverse flow in umbilical artery, but normal ‘A wave’ in ductus venosus. Eight fetuses died in neonatal period (16.6%). The indications for delivery of the live born neonates which were subsequently died were nonreassuring CTG in three cases, reverse flow in UA and in a wave of DV in three cases, and reverse flow detected in UA in one case. Six cases were delivered between 26–28 weeks, and early neonatal death was observed in two cases. Among the 32 cases delivered between 28–32 weeks, fetal death is observed in one case and six of 31 live born neonates delivered between 28–32 weeks were subsequently died in neonatal period. All fetuses delivered at or beyond 34 weeks were survived. Conclusions: ARED in UA Doppler is an ominous finding associated with high perinatal mortality, and the mortality rate decreases as the gestational age at delivery advances.