Umbilical vein pulsations and acid-base status at cordocentesis in growth-retarded fetuses with absent end-diastolic velocity in umbilical artery.

Abstract

The objective of this study was to examine the acid-base status in blood obtained at cordocentesis in growth-retarded fetuses with absent end-diastolic velocity in the umbilical artery and divided according to the presence or absence of pulsations in the umbilical vein. Twenty-six growth-retarded fetuses free from structural and chromosomal abnormalities were considered for this study. All the fetuses had absent end-diastolic velocity in the umbilical artery associated in 11 cases (42.3%) with pulsations in the umbilical vein. Gas analysis of fetal blood obtained by cordocentesis was performed immediately after the Doppler recordings. Hypoxemia, acidemia and hypercapnia were defined respectively as the presence of pH or pO2 values 2 standard deviations below the normal mean for gestation and of pCO2 values 2 standard deviations above the normal mean for gestation. Fetuses with umbilical vein pulsations had lower values of pH (p < or = 0.001) and pO2 (p < or = 0.05) and higher values of pCO2 (p < or = 0.001) when compared to those without pulsations. All fetuses with pulsations were hypoxemic and hypercapnic and the incidence of acidemia was 90.9%. Fetuses with continuous blood flow in the umbilical vein, although frequently hypoxemic (80%), have pCO2 and pH values within the normal range in 40 and 52.3% of the cases, respectively. In conclusion, in fetuses with absent end-diastolic velocity in the umbilical artery the presence of umbilical vein pulsations identifies a subgroup of fetuses with a more severe compromise of acid-base status. This may be useful in the selection of the timing of delivery of such fetuses.