Significance of abnormal umbilical artery Doppler studies in normally grown fetuses

Nebras Abu Al Hamayel,Haitham Baghlaf,Karin Blakemore,Jude P Crino,Irina Burd

doi:10.1186/s40748-020-0115-7

Abstract

ObjectiveTo determine whether there is a relationship between abnormal umbilical artery Doppler studies (UADS) and small for gestational age (SGA) birth weight and other adverse perinatal outcomes in fetuses that appear normally grown by ultrasound.MethodsThis was a retrospective study of all women who had UADS performed at or after 26 weeks of gestation at our institution between January 2005 and December 2012. Women were excluded if they had a fetal demise, a fetus with growth restriction, a fetus with congenital anomaly, or a multiple gestation. Women with missing delivery outcomes were excluded. The primary outcome was birth weight below the 10th percentile.ResultsThere were 2744 women included in the study. Of those, 98 (3.6%) had an abnormal UADS, and 379 (13.8%) had an SGA neonate. Of the 2646 women who had a normal UADS, 353 (13.3%) women had an SGA neonate. Twenty-six (26.5%) of the 98 women who had an abnormal UADS had an SGA neonate. After adjusting for potential confounders, the adjusted odds ratio for an SGA neonate with an abnormal UADS was 2.2 (95% CI, 1.38–3.58; p < 0.05). In examining other adverse perinatal outcomes, neonatal intensive care unit (NICU) admission and low 5-min Apgar scores were 12.4 and 2.3%, respectively. The adjusted odds ratio for NICU admission was 1.84 (95% CI, 1.06–3.21; p < 0.05). Abnormal UADS was not associated with low Apgar scores (aOR 1.39: 95% CI 0.47–4.07; p > 0.05).ConclusionsOur data suggest that abnormal UADS in fetuses that appear normally grown by ultrasound are associated with SGA neonates and NICU admission.

Highlights

Small for gestational age (SGA) birth weight affects 11% of neonates born in the United States, with African Americans being the highest prevalence group at 17% [1]
Women who had an abnormal Umbilical artery Doppler studies (UADS) were more likely to be African Americans, more likely to be diagnosed with hypertensive diseases and placenta previa, and more likely to deliver at an earlier gestational age (p < 0.05) (Table 1)
Subgroup analysis We examined the associations between abnormal UADS, neonatal intensive care unit (NICU) admission, and low Apgar score among SGA neonates

Summary

Introduction

Small for gestational age (SGA) birth weight affects 11% of neonates born in the United States, with African Americans being the highest prevalence group at 17% [1]. SGA is an adverse perinatal outcome that contributes to neonatal mortality and morbidity such as polycythemia, hyperbilirubinemia, hypoglycemia, hypothermia, apnea, asphyxia, seizures, and sepsis [2–4]. Umbilical artery Doppler studies (UADS), a noninvasive measure of the fetal hemodynamic state [10], are beneficial for monitoring growth restricted fetuses in order to predict their associated perinatal outcomes and to further manage them [11–13]. The Society for Maternal-Fetal Medicine, under the “Choosing Wisely” campaign, recommends against screening for fetal growth restriction using Doppler studies. Despite such recommendations, physicians and ultrasonographers are sometimes left with abnormal results in normally grown fetuses when performing a Doppler study. Studies that examine the associations between abnormal UADS in normally grown fetuses and adverse perinatal outcomes are limited [14–17]

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