This Article Full Text Full Text (PDF) Earn FREE CME Credit Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mari, G. Articles by Kruger, M. Search for Related Content PubMed PubMed Citation Articles by Mari, G. Articles by Kruger, M.

Gestational Age at Delivery and Doppler Waveforms in Very Preterm Intrauterine Growth-Restricted Fetuses as Predictors of Perinatal Mortality

Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan USA (G.M., F.H., M.K.); and University of Michigan, Ann Arbor, Michigan USA (M.C.T.).

Address correspondence to Giancarlo Mari, MD, Department of Obstetrics and Gynecology, Wayne State University, John R, Hutzel Hospital, 7 Brush, Detroit, MI 48201 USA. E-mail: gmari{at}med.wayne.edu

Objective. The aim of this study was to compare gestational age at delivery and the performance of middle cerebral artery (MCA), ductus venosus (DV), and umbilical artery Doppler parameters in the prediction of perinatal mortality and morbidity in intrauterine growth-restricted (IUGR) fetuses delivered at 32 weeks or earlier. Methods. The study population consisted of 41 patients with IUGR fetuses. Delivery occurred for maternal or fetal indications. Two-tailed ² and Fisher exact tests, an independent t test, and logistic regression were used for the analysis. P < .05 was considered statistically significant. Results. Gestational age at delivery ranged between 23.1 and 32 weeks (median, 27.6 weeks). There were 17 perinatal deaths. Ninety-four percent of the perinatal deaths occurred when the fetuses were delivered before 29 weeks. No fetus survived when delivered before 25 weeks. Two parameters predicted the perinatal mortality: gestational age at delivery (odds ratio, 0.52; 95% confidence interval, 0.31–0.88) and the combination of abnormal MCA peak systolic velocity + DV reversed flow (odds ratio, 10.2; 95% confidence interval, 1.8–57). For each week of pregnancy, there was a reduction in perinatal mortality of 48%. No Doppler parameters were significantly associated with perinatal morbidity. Conclusions. Gestational age at delivery and the combination of abnormal MCA peak systolic velocity + DV reversed flow in very preterm IUGR fetuses were the best parameters in predicting perinatal mortality. The decreased perinatal mortality that is found for each week IUGR fetuses remain in utero should be taken into account when a decision to deliver an IUGR fetus before 30 weeks is made.

Key Words: biophysical profile • ductus venosus • middle cerebral artery • peak systolic velocity • pulsatility index

Abbreviations: ARF, absent/reversed flow • CI, confidence interval • DV, ductus venosus • GA, gestational age • IUGR, intrauterine growth restriction • MCA, middle cerebral artery • PI, pulsatility index • PSV, peak systolic velocity • RF, reversed flow • UA, umbilical artery

This article has been cited by other articles:

				F. M. Severi, C. Boni, L. Bruni, C. Bocchi, R. A. Aguiar, F. M. Reis, and F. Petraglia The Increase of Blood Flow in the Fetal Middle Cerebral Artery Correlates With the Onset of Labor at Term Reproductive Sciences, July 1, 2008; 15(6): 584 - 590. [Abstract] [PDF]

				G. Mari, F. Hanif, K. Drennan, and M. Kruger Staging of Intrauterine Growth-Restricted Fetuses J. Ultrasound Med., November 1, 2007; 26(11): 1469 - 1477. [Abstract] [Full Text] [PDF]