Abnormal umbilical artery velocimetry and neonatal outcome

Background: Umbilical doppler pattern is one of the most widely used test to assess placental blood flow. In Umbilical artery doppler studies placental vascular insufficiency is reflected as abnormal diastolic flow. Absent or reversed diastolic flow is associated with fetal hypoxia and acidosis which need immediate termination of pregnancy, thus increasing caesarean sections and also prematurity related complications.
Methods: This prospective cohort study was conducted in the Departments of Obstetrics and gynaecology & Paediatrics, Govt Medical College, Thrissur from February 2014 to December 2014. Neonatal outcome of babies of 201 antenatal mothers with singleton pregnancies diagnosed with abnormal umbilical artery Doppler flow were studied till ostnatal day 28 or till the date of hospital discharge whichever is later. The maternal and neonatal characteristics were compared between the reduced diastolic flow group forward end diastolic flow, FEDF] and absent or reversal of diastolic flow roup [AREDF]. Babies with major malformations were excluded while comparing the neonatal outcome.
Results: All neonates with AREDF group needed NICU admission but only 50% of FEDF needed NICU admission. Mean duration of NICU stay in AREDF group was 20 days when compared to FEDF group, which was 7days. Incidence of prematurity, IUGR (intrauterine growth restriction) and low birth weight were significantly higher in AREDF group when compared to FEDF group. Mean birth weight is significantly low in AREDF group (1.141 kg) when compared to FEDF group (1.96kg); p value 0.000). Perinatal asphyxia was higher in AREDF group when compared to FEDF group (1 minute apgar.3.88; vs 8.29; p value 0.000). There were 44.1% still birth in AREF (FEDFgroup; 1.2%; p value 0.000) and 17.6% neonatal death in ARED flowgroup. (FEDF group; 6.1%; p value 0.000). Only 3(23%) babies with reversal of diastolic flow survived. Prematurity related complications like HMD (hyaline membrane disease), apnoea of Prematurity, feed intolerance, NEC (necrotising enterocolitis) were higher in AREDF group and it was statistically significant. Absent or reversal of end diastolic flow was more in those mothers with preeclampsia and this difference was tatistically significant Conclusions: Doppler velocimetry is a noninvasive and safe imaging modality of indirectly assessing the fetal and uteroplacental circulation and plays an important role in detecting Intra Uterine Growth Restriction (IUGR). It helps in timely intervention balancing prematurity and intrauterine death. AREDF directly correlates with NICU admission