Abnormal ductus venosus pulsatility index in the absence of concurrent umbilical vein pulsations does not indicate worsening fetal condition

Abstract

Objective: Recordings of blood flow velocity waveforms in the ductus venosus (DV) and umbilical vein (UV) are routinely used in order to predict fetal condition in high-risk pregnancies. The aim of this study was to investigate the relationship between pathological blood flow in the two vessels and perinatal outcome. Methods: High-risk pregnancies (n = 11 863) admitted from 1993 to 2011 for blood-flow examination, including recordings of DV pulsatility index for veins (DV-PIV) and UV pulsations, were included. The results were related to perinatal outcome, using the last Doppler examination prior to delivery in the analysis. Results: Abnormal DV-PIV was observed in 3.9% of cases, intra-abdominal UV pulsations in 1.3% and pulsations in the cord in 0.7%. As expected, the rate of UV pulsations increased with increasing DV-PIV Z-score. Fetuses with a pathological DV-PIV, but without UV pulsations, showed fewer signs of compromise. This was also true for cases with a DV-PIV ≥ 4 SDs above the mean (53.7% had steady flow in the UV). In contrast, the occurrence of UV pulsations seemed to be an indicator of fetal compromise, regardless of level of DV-PIV. Conclusions: Abnormal fetal venous blood velocity is related to adverse outcome in high-risk pregnancies. However, abnormal DV-PIV is not a reliable indicator of fetal compromise unless UV pulsations are concurrently present, and should not be regarded an indication for emergency delivery. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.