Journal of Ultrasound in Medicine, Vol 13, Issue 2 73-80, Copyright © 1994 by American Institute of Ultrasound in Medicine
Diabetes mellitus in pregnancy and the assessment of umbilical artery waveforms using pulsed Doppler ultrasonography
E. A. Reece, Z. Hagay, E. Assimakopoulos, W. Moroder, S. Gabrielli, N. DeGennaro, C. Homko, T. O'Connor and A. Wiznitzer
Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA 19140.
The utility of Doppler ultrasonography as a means of assessing potential
alterations of vascular resistance prior to fetal or maternal compromise is
very attractive. We investigated this relationship by prospectively
performing Doppler studies of the fetal umbilical artery in 56 diabetic
patients, 14 of whom had varying degrees of vascular complications. When
regression curves were established for the S/D ratio, the Pourcelot index,
and the resistance index of the fetal umbilical artery, the mean Doppler
values were higher in diabetic patients with vasculopathy than in
nondiabetic control patients or in diabetic patients without vasculopathy.
The third trimester S/D ratio was greater than 3.0 in almost 50% of
patients with vasculopathy. A tendency toward adverse outcomes was observed
at S/D ratios approaching 4.0. Statistically significant correlations were
found between elevated Doppler indices and maternal vasculopathy associated
with hypertension and worsening renal insufficiency. Intrauterine growth
retardation and neonatal metabolic complications were also significantly
correlated with elevated Doppler indices. There was, however, no
correlation between Doppler indices and glucose values, although most were
within a euglycemic range. The aforementioned data indicate an increased
resistance circuit among diabetics with vasculopathy, which may reflect a
relative reduction in basal uteroplacental blood flow and the need for
cautious interpretation of Doppler indices in these patients.
