The ability of continuous-wave Doppler ultrasound to detect fetal growth restriction.

Ute Feucht,Valerie Vannevel,Robert Pattinson,Helen Mulol,Stefan Gebhardt

doi:10.1371/journal.pone.0255960

Ute Feucht, Valerie Vannevel + Show 3 more

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https://doi.org/10.1371/journal.pone.0255960

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Abstract

BackgroundFetal growth restriction (FGR), defined as a fetus failing to reach its genetic growth potential, remains poorly diagnosed antenatally. This study aimed to assess the ability of continuous-wave Doppler ultrasound of the umbilical artery (CWD-UmA) to detect FGR in healthy women with low-risk pregnancies.Methods and findingsThis prospective longitudinal descriptive cohort study enrolled infants born to low-risk mothers who were screened with CWD-UmA between 28–34 weeks’ gestation; the resistance index (RI) was classified as normal or abnormal. Infants were assessed at 6, 10, 14 weeks, and 6 months postnatally for anthropometric indicators and body composition using the deuterium dilution method to assess fat-free mass (FFM). Neonates in the abnormal RI group were compared with those in the normal RI group, and neonates classified as small-for-gestational age (SGA) were compared with appropriate-for-gestational age (AGA) neonates.Eighty-one term infants were included. Only 6 of 26 infants (23.1%) with an abnormal RI value would have been classified as SGA. The abnormal RI group had significantly reduced mean FFM and FFM-for-age Z-scores at 6, 10, 14 weeks, and 6 months compared with the normal RI group (P<0.015). The SGA group’s FFM did not show this consistent trend when compared to AGA FFM, being significantly different only at 6 months (P = 0.039).The main limitation of the study was the small sample size of the infant follow-up.ConclusionsAbnormal RI obtained from CWD-UmA is able to detect FGR and is considered a useful addition to classifying the neonate only by SGA or AGA at birth.

Highlights

Fetal growth restriction (FGR) is a major contributor to stillbirth, stunting, poor neurodevelopment, and childhood obesity as well as obesity, type-two diabetes mellitus, hypertension, and strokes in adults [1,2,3,4]
Abnormal resistance index (RI) obtained from continuouswave Doppler ultrasound of the umbilical artery (CWD-umbilical artery (UmA)) is able to detect FGR and is considered a useful addition to classifying the neonate only by small-for-gestational age (SGA) or appropriate-for-gestational age (AGA) at birth
This study examined whether a continuous wave Doppler ultrasound (CWD)-UmA cut-off determined by perinatal mortality for RI charts [8] in healthy women with pregnancies classified as low risk can detect evidence of FGR measured by postnatal infant body composition, and compared it to the standard method of diagnosing FGR, namely assessing birth weight (BW) with respect to gestational age (GA) and classifying neonates as small-for-gestational age (SGA; conventionally as

Summary

Introduction

Fetal growth restriction (FGR) is a major contributor to stillbirth, stunting, poor neurodevelopment, and childhood obesity as well as obesity, type-two diabetes mellitus, hypertension, and strokes in adults [1,2,3,4]. In Mamelodi in Pretoria, South Africa, screening of healthy, low-risk pregnant women using the low-cost continuous wave Doppler ultrasound (CWD) UmbiflowTM device found abnormal RIs in 11.7%, including absent end diastolic flow indicating end-stage placental insufficiency in 1.5% [12]. The use of this RI information resulted in a 42% reduction in perinatal mortality when compared with similar pregnant women without such CWD-UmA assessment. This study aimed to assess the ability of continuouswave Doppler ultrasound of the umbilical artery (CWD-UmA) to detect FGR in healthy women with low-risk pregnancies

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