Importance of ductus venosus Doppler assessment for fetal outcome in cases of intrauterine growth restriction.

Objective: The measurement and evaluation of ductus venosus (DV) blood flow velocity waveform in high-risk pregnancies has been studied intensively in recent years in order to find a more intermediate signal of fetal compromise. Our objective was to study the fetal outcome of pregnancies with intrauterine growth retardation (IUGR) and normal pulsatility of DV compared to an IUGR group with increased DV pulsatility.

Methods: The outcome of 42 fetuses before 32 weeks of gestational age without chromosomal or structural aberrations was analyzed. All fetuses showed IUGR <5th percentile based on placental insufficiency diagnosed by pathologic RI >90th percentile of both maternal uterine arteries. One group (30 fetuses; mean weight 730 g/SD 190 g; mean gestational age 197 days/SD 12 days) showed normal, the other (12 fetuses, mean weight 675 g/SD 179 g; mean gestational age 198 days/SD 12 days) reduced, but neither absent nor reverse DV flow during atrial contraction. All 42 fetuses were delivered by cesarean section because of severe variable or prolonged decelerations. We measured blood flow velocities of the DV in every fetus on an average 3.7 days (range 1-5 days) before cesarean section. Fetal outcome was determined by Apgar scores after 5 and 10 min, arterial pH and base excess; neonatal morbidity was recorded by intensive follow-up.

Results: There were no significant differences of pH, umbilical artery base excess, Apgar scores and severe neonatal complications between the two groups.

Conclusions: Our own data show no correlation between increased pulsatility in the DV (without absent or reverse flow during atrial contraction) and fetal outcome before 32 gestational weeks, even in cases of severe growth restriction based on placental insufficiency. Therefore in these cases reduced DV flow during atrial contraction should cautiously be interpreted regarding obstetrical decisions.