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Combination of Fetal Doppler Velocimetric Resistance Values Predict Acidemic Growth-Restricted Neonates

Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan (J.H.H., J.H.); and Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan (C.Y.F.).

Address correspondence to Jeng Hsiu Hung, MD, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Rd, Taipei 112, Taiwan. E-mail: jhhung{at}vghtpe.gov.tw

Objective. This study was undertaken to determine the efficacy of combination Doppler velocimetric resistance values of the umbilical artery and ductus venosus in predicting growth-restricted neonates with acidemia. Methods. This retrospective case-control study included 61 gravidas complicated by intrauterine growth restriction with acidemia and 65 control pregnancies. The Doppler velocimetric resistance values obtained from the growth-restricted and control fetuses were in turn compared with the median values derived from another 192 normal pregnancies to adjust the biometric bias due to gestational age. Results. Based on the pulsatility index of the umbilical artery and pulsatility index for the vein of the ductus venosus, the areas under the receiver operating characteristic curves were 0.7992 and 0.6749, respectively, for predicting growth-restricted neonates with acidemia. With a combination of the pulsatility indices of the umbilical artery and the pulsatility indices for the vein of the ductus venosus, the predictive accuracy of the growth-restricted neonates with acidemia increased, with sensitivity of 0.79 and specificity of 0.79 and an area under the receiver operating characteristic curve of 0.8441. Conclusions. Compared with single-vessel assessment, combining the pulsatility indices of the umbilical artery and the pulsatility indices for the vein of the ductus venosus provides the greatest accuracy in predicting growth-restricted neonates with acidemia.

Key Words: ductus venosus • intrauterine growth restriction • umbilical artery • velocimetry

Abbreviations: DVPIV, ductus venosus vein pulsatility index • GA, gestational age • IUGR, intrauterine growth restriction • MoM, multiple of the median • PEV, proportion of explained variation • PI, pulsatility index • PIV, pulsatility index for the vein • ROC, receiver operating characteristic • UMBAPI, umbilical artery pulsatility index