Management of fetuses with absent/reversed end-diastolic flow (AREDF) in the umbilical artery: outcome of a policy of daily biophysical profile (BPP)

Abstract

This study aimed to evaluate a management strategy of daily BPP for fetuses with AREDF in the umbilical artery. This was a retrospective review (1994–2002) of outcome in 133 non-anomalous fetuses with AREDF referred to a tertiary centre. Delivery was timed on the basis of an abnormal BPP or gestation > 34 weeks. The mean (SD) gestation at diagnosis was 28.8 (4.4) weeks, and at delivery was 30.4 (4.2) weeks. There were 42 (32%) perinatal deaths, including 30 (23%) in-utero deaths [birth weight 521 (196) g], seven (5%) neonatal deaths [715 (128) g] and seven (5%) terminations of pregnancy [389 (141) g]. Mean birth weight of surviving infants was 1326 (727) g. For the 96 livebirths, 20 (21%) were delivered at gestation ≥ 34 weeks, 11 (11%) for pre-eclampsia and 44 (46%) for abnormal biophysical monitoring (17 for a BPP score =4/10, nine for two equivocal BPPs (score 6/10) and 18 for a single equivocal BPP (of which the key prompt in eight was a pathological CTG). A pathological CTG prompted delivery in a further 12 fetuses where the ultrasound components of the BPP were normal (i.e. 8/8). There was one abruption, and eight (8%) babies delivered for other reasons. ‘Unexpected’ IUDs (i.e. within 24 hours of a normal BPP) occurred in five (4%) cases between 26+1 and 29+0 weeks. These pregnancies were complicated by either proteinuric hypertension (three) or preterm amniorhexis (two). In one case, an equivocal BPP was not repeated within 24 hours.