Comparision of Doppler Indices and Cord Blood PH Parameters Among Intrauterine Growth Restricted Fetuses

Öz

Objectives: Assessment of pregnancy outcomes among intrauterine growth restricted fetuses with Doppler indices and cord blood gases

Methods: This study was conducted in May 2014 and January 2015. A total of 32 cases who had intrauterine growth restricted fetuses were included in this study.  Cases were grouped as normal flow in the umblical artery (n=17) and absent or reversed end-diastolic flow in the umbilical artery (11 and 4 cases respectively). In addition to these cases, 3 cases had reversed a waveform in ductus venosus. 

Results: There was no neonatal mortality among the cases had normal flow in the umblical artery. However, mortality rate was %40 (n=6) among the cases had absent or reversed end-diastolic flow. The mean birth weights  were 2118gr in the normal group and 968gr in the abnormal umblical artery Doppler group (p:0.001). The mean Apgar score at 5 minutes was higher in the normal flow group (7,65) than the abnormal umblical artery Doppler group (6,27) and this difference was statistically significant (p:0.001). The neonatal intensive care admissions were significantly increased in the abnormal group. The mean durations of hospitalization were 6,58 days in normal group and 39,93 days in abnormal group. The mean umbilical arterial pH and base excess were significantly higher in the normal group (p:0.016, p:0.004). The mean umblical arterial pH of normal group and abnormal group were 7,33 and 7,24 respectively.

Conclusion:  There is a strong relationship between pregnancy outcome in IUGR fetuses and abnormal uterine artery doppler waveform (absent or reversed) and ductus venosus waveform. Furthermore, Doppler examination can be safely used to management of these fetuses and to determine delivery time. Also, delivery of IUGR fetuses before detection of  absent a wave in the ductus venosus should be considered. 

Anahtar Kelimeler

• Intrauterine growth restriction,Doppler

İntrauterin Gelişme Geriliği Olan Fetusların Doppler Akımları ile Doğumdaki Fetal Kan Ph Değerlerinin Karşılaştırılması

Öz

Amaç: Intrauterin gelişme geriliği olan fetusların Doppler akımları ile doğumdaki kan pH değerlerinin perinatal ve neonatal sonuçlar açısından değerlendirilmesi amaçlandı.

Materyal Method: Mayıs 2014 ve Ocak 2015 tarihleri arasında intrauterin gelişme geriliği (IUGR) tanısı konan 32 hasta çalışmaya alındı. Hastalar umblikal arterde akım kaybı olmayan (17 hasta) ve umblikal arterde akım kaybı (11 hasta) veya ters akım olan (4 hasta) olmak üzere iki gruba ayrıldı. Ayrıca 3 hastada duktus venosusta ters a dalgası mevcuttu.  

Bulgular: Umblikal arterde akım kaybı olmayan grupta neonatal mortalite görülmezken, umblikal arterde akım kaybı veya ters akım olan grupta %40 mortalite izlendi. Akım kaybı olmayan grubun doğum ağırlıkları ortalaması (2118gr), patolojik akım grubundan (968 gr) istatistiksel olarak anlamlı düzeyde yüksek saptandı (p:0.001). Akım kaybı olmayan grubun apgar 5.dk skor ortalaması (7,65), patolojik akım grubundan (6,27) istatistiksel olarak anlamlı düzeyde yüksek saptandı  (p:0.001). Akım kaybı olmayan grubun yeni doğan yoğun bakım ünitesine yatış süreleri (6,58 gün), patolojik akım grubundan  (39,93 gün) istatistiksel olarak anlamlı düzeyde düşük bulundu (p:0.001). Akım kaybı olmayan grupta baz açığı ortalaması(-0,75), patolojik akım grubundan (-5,76) istatistiksel olarak anlamlı düzeyde yüksek saptandı (p:0.004). Akım kaybı olmayan grubun pH ortalaması (7,33), patolojik akım grubundan (7,24)  yüksek saptandı (p:0.016).

Sonuç:  İntrauterin gelişme geriliği olan fetusların takibinde ve doğum zamanlamasında  Doppler ultrasonda umblikal arter ve ductus venosus ölçümleri güvenle  kullanılabilir. İntrauterin gelişme geriliği olan fetuslar duktus venosusta a dalgası kaybı olmadan doğurtmak gerekmektedir.

Anahtar Kelimeler

• İntrauterin gelişme geriliği,Doppler

Kaynakça

1. 1- Jacobsson B, Ahlin K, Francis A ,et al : Cerebral palsy and restricted growth status at birth : Population-based case-control study. BJOG 115:1250,2008
2. 2-Wu YW, Croen LA , Shah SJ ,et al : Cerebral palsy in term infants. Pediatrics 118:690,2006
3. 3-Pardi G, Cetin I : Human fetal growht and organ development: 50 years of discovers . Am J Obstet Gynecol 2006;194:1088
4. 4- The American College of Obstetricians and Gynecologists. Intrauterine Growth Restriction. ACOG Practice Bulletin 12. Washington, DC: ACOG; 2000
5. 5. Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999; 84: 139-47
6. 6. Belloti M, Pennati G, Pardi G, Fumero R. Dilatation of the ductus venosus in human fetuses: Ultrasonographic evidence and mathematical modeling. Am J Physiol 1998; 275: 1759-67
7. 7. Rizzo G, Capponi A, Talone PE, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus veno-sus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth retarded fetuses. Ultrasound Obstet Gynecol 1996;7:401-10
8. 8- Hecher K, Snijders R, Campbell S, Nicolaides K. Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: relationship with fetal blood gases. Am J Obstet Gynecol 1995; 173: 10-5

9. 9- Rizzo G, Capponi A, Arduini D, Romanini C. Ductus veno-sus velocity waveforms in appropriate and small for gesta-tional age fetuses. Early Hum Dev 1994; 39: 15-267
10. 10-Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gyne-col 2001; 18: 571-7
11. 11. Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelôer BJ, Kok HJ. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564-70
12. 12. Hofstaetter C, Dubiel M, Gudmundsson S. Two types of umbilical venous pulsations and outcome of high-risk pregnancy. Early Hum Dev 2001; 61: 111-7
13. 13. Müller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
14. 14. Ertan AK, He JP, Tanriverdi HA, Hendrik HJ, Limbach H, Schmidt W. Comparison of Perinatal Outcome in Fetuses with Reverse or Absent Enddiastolic Flow in the Umbilical Artery / Fetal Descending Aorta. J Perinat Med 2003;31:307-12
15. 15. Valcamonico A, Danti L, Frusca T, et al. Absent end-di-astolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994; 170: 796-801
16. 16. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 1995;172:1379-87
17. 17. Baschat AA, Gembruch U, Viscardi RM, Gortner L, Har-man CR. Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler? Ultrasound Obstet Gynecol 2002;19:334-9
18. 18. Ozyuncu O, Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications Turk J pediatri 2010: 52;384-392
19. 19. O.M.Turan Duration of persistent abnormal ductus venosus flow and its impact on perinatal outcome in fetal growth restriction ultrasound obstet gynecol 2011;38:298-302
20. 20.Cosmi E, Ambrosini G, D’Antoro D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth - restricted fetuses. Obstet Gynecol 2005; 106: 1240-45.
21. 21.Muller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
22. 22. Bonatz G, Schulz V, Weisner D, Jonat W. Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis. J Perinat Med 1997; 25: 440-6
23. 23. Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of a loss of end- diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound. Gynecol Obstet Invest 1988;25:173-80
24. 24. Divon MY, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002;45:1015-25
25. 25. Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical veloci- metry. Obstet Gynecol 1997;90:953-7
26. 26.Hofstaetter C, Gudmundsson S, Hansmann. Venous Dopp-ler velocimetry in the surveillance of severly compromised fetuses. Ultrasound Obstet Gynecol 2002; 20: 233-9