Prognostic value of uterine artery doppler velocimetry in growth-restricted fetuses delivered near term

Abstract

Objective: We have investigated the use of uterine artery Doppler waveform analysis in growth restricted fetuses delivered at ≥34 weeks. Study Design: Included in the study were all consecutive euploid nonmalformed singleton fetuses with accurate dating diagnosed as growth restricted (sonographic abdominal circumference <10th percentile) between January 1995 and December 1998 and who were delivered at ≥34 weeks. Delivery was expedited for biophysical profile 6 or less with nonreactive nonstress test, preeclampsia, oligohydramnios, absent fetal growth over 2 weeks, absent or reversed diastolic flow in the umbilical artery (UA), or UA pulsatility index (PI) greater than the 95th percentile after 37 weeks. Neonatal outcomes were compared in cases with normal versus abnormal Doppler waveforms at the uterine arteries (defined as average resistance index >0.58 or presence of bilateral notching) using one-way analysis of variance, χ2 test, and logistic regression analysis. A two-tailed P <.05 or an odds ratio (OR) with 95% CI not inclusive of the unity was considered significant. Results: Growth-restricted fetuses with abnormal (n = 109) versus normal (n = 185) Doppler velocimetry results at the uterine arteries had similar ratios of head-to-abdominal circumference at diagnosis, but asymmetric body proportion at the last scan before delivery. Neonates of mothers with abnormal uterine artery Doppler waveforms were more frequently born of cesarean delivery, particularly for nonreassuring fetal testing (27% vs 10%, P <.001), had significantly lower gestational age at delivery (37.7 ± 2.0 vs 38.8 ± 1.6, P <.001), and lower birth weight percentiles (4.8 ± 5.1 vs 9.3 ± 10.2, P <.001). More importantly, although 5-minute Apgar scores and UA pH values were not significantly lower, they had a significantly greater risk of admission to intensive care unit for reasons other than low birth weight alone (36% vs 11%). After preeclampsia was controlled, such risk was associated with an OR of 4.1 (95% CI 2.2-7.5). Conclusion: In growth-restricted fetuses delivered at ≥34 weeks, presence of abnormal Doppler waveforms at the uterine arteries at diagnosis is associated with a 4-fold increased risk of adverse neonatal outcome. (Am J Obstet Gynecol 2002;187:932-6.)