Abstract
Objective. Abnormal umbilical artery Doppler (UAD) studies are associated with poor neonatal outcomes. We sought to determine if postnatal measures of systemic blood flow (SBF), as measured by functional echocardiography (fECHO), could identify which fetuses with abnormal UAD were at the highest risk of adverse outcomes. Study Design. This is a retrospective review of fetuses with abnormal UAD who received fECHO in the first 72 hours of life. Measures of SBF (right ventricular output (RVO) and superior vena cava (SVC) flow) were performed and compared with prenatal variables and postnatal outcomes. Result. 63 subjects had abnormal UAD, 20 of which also had fECHO. Six subjects had abnormal flow. Gestational age at delivery was similar between the two groups. Those with abnormal SBF had fewer days of abnormal UAD prior to delivery and developed RDS (P < 0.001). Conclusion. Postnatal measures of SBF were associated with poor postnatal outcomes in fetuses with abnormal UAD. Future studies incorporating antenatal measures of SBF may help obstetricians determine which pregnancies complicated by UAD are likely to have postnatal morbidity.
Highlights
Abnormal fetal umbilical artery Doppler (UAD) studies represent a problem that is complex in both antenatal prevention and management and postnatal management [1]
63 subjects were identified with abnormal uterine artery Doppler studies; 20 subjects had both abnormal UAD and functional echocardiography (fECHO) performed within the first 72 hours of life
The maternal demographics were overall similar between the two groups with the exception of age, which was lower in the abnormal fECHO group (Table 1)
Summary
Abnormal fetal umbilical artery Doppler (UAD) studies represent a problem that is complex in both antenatal prevention and management and postnatal management [1]. Reversed end-diastolic flow (REDF) is the most advanced stage of abnormal umbilical artery Doppler flow and represents obliteration of nearly 70% of the placental function [3]. The fetus responds with an increase in red blood cell mass and shunting of blood to nonessential vascular beds in order to increase oxygen utilization [5, 6]. This results in preferential cardiac and cerebral blood flow, with reduced blood flow to the rest of the body [7, 8]. The fetal right ventricular afterload increases in the setting of myocardial impairment, and changes in the fetal ductus venosus can often be visualized as a late and ominous finding [9]
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