Prognostic Factors for Survival of Growth-Restricted Fetuses With Absent End-Diastolic Velocity in the Umbilical Artery

Abstract

OBJECTIVE The aim of the study was to evaluate the prognostic factors for survival of growth-restricted fetuses with absent end-diastolic velocity in the umbilical artery. STUDY DESIGN Forty-five intrauterine growth-restricted fetuses with either absent end-diastolic (34 fetuses) or reverse flow (11 fetuses) in the umbilical artery were studied. The clinical characteristics of these pregnancies were determined. Logistic regression analysis was conducted to find the relative value of gestational age at birth, thoracic artery and middle cerebral artery Doppler velocimetry, and short-term variability determined by cardiotochography in the prediction of perinatal mortality. RESULTS The mean gestational age at birth and birth weight were 30.8+/-2.4 weeks and 972+/-337 g, respectively. The perinatal mortality was 40%. Gestational age at birth was found to have the only significant contribution to the prediction of perinatal deaths. Fetuses with a gestational age at delivery less than 29 weeks died and more than 31 weeks survived. Thoracic artery pulsatility index had the best screening efficiency for predicting perinatal mortality between 29 and 31 weeks gestational age. CONCLUSION Absent end-diastolic velocity in the umbilical artery is mainly a problem of severe preterm growth-restricted fetuses and is associated with high perinatal mortality. The major and dominant influence on survival is gestational age at birth.