Document Detail


Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction.
MedLine Citation:
PMID:  14770388     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This article provides an opinion on a study of relationships between umbilical artery (UA) Doppler, ductus venosus (DV) Doppler, fetal heart rate variation, and perinatal outcome in preterm, intrauterine growth-restricted (IUGR) fetuses published in the same issue of this journal by Bilardo and coworkers. Recent evidence on venous Doppler surveillance in preterm IUGR fetuses was also reviewed and discussed in the context of the study with a special emphasis on delivery timing. A search was conducted through MEDLINE and eight articles with similar inclusion criteria and reporting format of outcomes were identified. Numbers for perinatal mortality, intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis (NEC) were extracted for cases where Doppler status was recorded in an identical format. Proportional distribution of outcomes was compared for fetuses with normal DV Doppler velocimetry, absent or reversed UA end-diastolic velocity (UA A/REDV), elevated DV Doppler index (abnormal DV) and absence or reversal of atrial velocity in the DV (DV-RAV). A total of 320 fetuses with normal and 202 with elevated DV Doppler indices were extracted. Of these fetuses, 101 with UA A/REDV only and 34 with DV-RAV were identified. Perinatal mortality was 5.6% (16/282) with normal DV, 11.9% (12/101) with UA A/REDV, 38.8% (64/165) with abnormal DV and 41.2% (7/17) with DV-RAV. With the exception of NEC, all complications were significantly more frequent with abnormal DV. With normal venous Doppler neonatal deaths account for most of the perinatal mortality, while with abnormal DV stillbirths and neonatal mortality are similar contributors to the significantly increased perinatal mortality. In conclusion, UA Doppler is a placental function test that provides important diagnostic and prognostic information in preterm IUGR. DV Doppler effectively identifies those preterm IUGR fetuses that are at high risk for adverse outcome (particularly stillbirth) at least 1 week before delivery, independent of the UA waveform. Relationships between perinatal outcome, arterial and venous Doppler status and gestational age require ongoing observational research effort. Randomized management trials are necessary to verify that delivery timing based on venous Doppler will impact on outcome in preterm IUGR.
Authors:
A A Baschat
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  23     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-10     Completed Date:  2004-05-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  111-8     Citation Subset:  IM    
Copyright Information:
Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Baltimore, MD 21201-1703, USA. aabaschat@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Biomedical Research
Delivery, Obstetric / methods*
Disease Progression
Female
Fetal Growth Retardation / ultrasonography*
Gestational Age
Humans
Pregnancy
Pregnancy Outcome
Time Factors
Ultrasonography, Doppler / methods
Ultrasonography, Prenatal / methods*
Umbilical Arteries / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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