Abstract
Objectives: To evaluate the independent and combined contribution to short-term predictive value for mortality in severe IUGR of clinically used and recently described cardiovascular Doppler parameters. Methods: Umbilical artery, middle cerebral artery, ductus venosus (DV), aortic isthmus flow index and modified-myocardial performance index (Mod-MPI) were measured in a cohort of 97 preterm IUGR fetuses. Logistic regression was performed to select those variables that were independently associated to perinatal mortality, and an algorithm to estimate probabilities of death was constructed including the best combination of parameters. Results: A combination of gestational age (below or above 28 weeks), DV atrial flow (positive or absent-reverse) and ModMPI (normal or above 95th percentile) had the highest predictive value for perinatal mortality in IUGR cases. An algorithm including these 3 parameters had a better predictive accuracy than any single parameter. The risk for death below and above 28 weeks respectively was: normal DV and Mod-MPI, 18% and 0.1%; either abnormal, 70–73% and 6–7%; both abnormal, 97% and 45%. Conclusions: The use of composite cardiovascular Doppler scores may help to refine considerably the short-term prediction of perinatal mortality at different gestational ages in severe IUGR fetuses.
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