Umbilical artery Doppler assessment in fetuses with a congenital heart disease

Abstract

Current data is conflicting regarding the utility of umbilical arterial (UA) Doppler assessment as a predictor of adverse perinatal outcomes in fetuses with congenital heart disease (CHD). We describe a cohort of fetuses with CHD who underwent serial UA Doppler surveillance. We performed a retrospective chart review of singleton fetuses with CHD who received prenatal care at our academic center between June 2018 and September 2020. Fetuses with chromosomal abnormality or fetal growth restriction were excluded. Serial UA Doppler data and perinatal outcomes were collected and fetuses with normal versus abnormal UA Doppler assessments were compared. Abnormal UA Doppler assessment was defined as elevated end diastolic flow >95th percentile or absent/reversed end diastolic flow. Of 310 fetuses with CHD identified, 55% (171/310) met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment throughout pregnancy, 47% (73/154) of whom had isolated CHD without extracardiac anomalies. Additionally, 17 fetuses had abnormal UA Doppler assessment, 71% (12/17) of whom had isolated CHD. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia (Table 1). CHD lesions varied, with the most common being isolated VSD (N=39, 23%), hypoplastic left heart syndrome (N=28, 16%), and Tetralogy of Fallot (N=20, 12%), but CHD type did not differ significantly between groups. Of those with normal UA Doppler assessment, 14% (21/154) had an adverse perinatal outcome (defined as fetal demise, neonatal demise, or infant death) compared to 24% (4/17) with abnormal UA Doppler assessment (p=.28, Table 2). We describe UA Doppler and adverse perinatal outcomes in a cohort of normally grown, euploid singleton fetuses with CHD. We did not find a statistically significant difference when comparing those with normal versus abnormal UA Doppler assessment. UA Doppler assessment alone is unlikely to predict adverse perinatal outcome in fetuses with CHD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)