Journal of Ultrasound in Medicine, Vol 10, Issue 6 309-315, Copyright © 1991 by American Institute of Ultrasound in Medicine
Role of umbilical Doppler velocimetry in the biophysical assessment of the growth-retarded fetus. Answers from neonatal morbidity and mortality
E. Ferrazzi, C. Vegni, M. Bellotti, A. Borboni, S. Della Peruta and A. Barbera
Department of Obstetrics and Gynecology, San Paolo Biomedical Sciences Institute, Milan, Italy.
We compared umbilical Doppler velocimetry with biophysical parameters,
obstetrical management, and neonatal morbidity. The study of 85 pregnancies
was prospective and blind both to the obstetric and pediatric staff. Our
results show that under the same biophysical diagnosis, ie, abnormal fetal
growth, oligohydramnios, and nonreactive cardiotocographics, the prevalence
of neonatal morbidity was significantly higher in fetuses with associated
abnormal umbilical pulsatility index (PI) in utero. Newborns with abnormal
PI were delivered earlier, mostly for fetal indication, and were smaller
and more asymmetrical than newborns with a normal PI in utero. The analysis
of morbidity for homogeneous classes of weight showed that in the group of
newborns between 1500 and 2500 g, newborns with normal umbilical PI did
show only metabolic disturbances and one respiratory distress syndrome. On
the contrary, newborns of the same gestational age and of the same weight
with abnormal PI had more severe morbid episodes. In the class of weight
between 1500 and 1000 g not only the severity but also the prevalence of
neonatal morbidity was significantly higher in newborns with an abnormal PI
in utero. None of the newborns delivered below 1000 g had a normal
umbilical PI. Five died in the early neonatal period. Three suffered from
mild neuromotor sequelae. Practical consequences of these findings on fetal
management are the scheduled frequency of biophysical examinations, which
must be closer and on an inpatient basis whenever abnormal, and the
interpretation of other abnormal biophysical parameters, which must be
considered as more severe whenever associated with an abnormal umbilical
velocimetry.
