Multivascular Doppler surveillance in high risk pregnancies

Abstract

Objectives: Analysis of fetal arterial and venous Doppler predictability for adverse perinatal outcome. Methods: Blood flow in the uterine, umbilical and middle cerbral arteries, umbilical vein, ductus venosus and Galen vein were examined with in 72 h of delivery in 88 high-risk pregnancies. The managing clinicians were only informed about the results of the umbilical artery Doppler. The Doppler results were correlated to adverse perinatal outcome. Results: Doppler abnormalities were seen in both preterm and term pregnancies. Umbilical venous pulsations (n = 13) were strongly correlated to Apgar score <7 at 5 min, abnormal blood gases, need for ventilation assistance and operative delivery for fetal distress. Twenty-four fetuses had brain sparing in the middle cerebral artery, and forty-five had abnormal umbilical artery Doppler. These were correlated to admission in the neonatal intensive care unit, operative delivery and prematurity. Brain sparing in middle cerebral artery was also correlated to ventilation disturbances in the newborns. Abnormal ductus venosus blood velocity was only seen in 9 cases and not related to adverse outcome. Galen vein pulsations (n = 26) seem to appear earlier than pulsations in the umbilical vein and were not related to adverse outcome. conclusion: Umbilical vein pulsations were better correlated to adverse perinatal outcome than were other Doppler findings including ductus venosus.

Keywords::

• Doppler ultrasound
• fetus
• perinatal outcome
• middle cerebral artery
• ductus venosus
• umbilical venous pulsations
• Galen vein

Acknowledgements

The University hospital in Malmö and Region Skåne supported the study. The laboratory assistants Lena Berg, Maria Nilsson, and Pia Soikkeli are highly acknowledged for performing the Doppler recordings.

Declaration of Interest: The authors report no declaration of interest.