Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction - 20/07/22
, Camille Driver, MA a, b, Diane Gumina, PhD a, b, Emma Peek, BS a, b, Teresa Harper, MD a, b, John C. Hobbins, MD a, b, Henry L. Galan, MD a, bAbstract |
Background |
Studies revealing a discrepancy in umbilical artery Dopplers between the two umbilical arteries in normally-grown fetuses necessitates further evaluation of the paired umbilical arteries in the setting of fetal growth restriction as this is a critical component in the surveillance of this population.
Objective |
Umbilical artery Doppler sampling in fetal growth restriction is typically assessed in 1 umbilical artery in a free loop of cord. Although discrepancies of >20% between the 2 umbilical arteries occur in 1 of 3 normal pregnancies, this has not been assessed in fetal growth restriction. Our objectives were to determine the frequency of discordant Doppler pulsatility indices between paired umbilical arteries in a fetal growth restriction cohort and to determine if sampling of 1 or both arteries alters surveillance or timing of delivery.
Study Design |
A cohort of 425 growth-restricted fetuses between 25 and 39 weeks of gestation had umbilical artery Doppler pulsatility indices determined from both umbilical arteries in a midsegment of the cord to determine: (1) the discrepancy percentage between paired umbilical artery pulsatility indices and (2) the frequency of both arteries being normal, abnormal, or discordant (pulsatility index < and >95th percentile). To determine what sampling method increased the detection of an abnormal Doppler index, 3 sampling methods were compared: (1) average pulsatility index from both umbilical arteries, (2) pulsatility index from 1 umbilical artery chosen randomly, and (3) highest pulsatility index of the 2 umbilical arteries.
Results |
The mean percentage difference between umbilical artery pulsatility indices was 11.7%, and in 15.8% of cases, it exceeded 20%. Both umbilical artery pulsatility indices were normal in 71.1% (302/425), abnormal in 12.2% (52/425), and discordant in 16.7% (71/425) of cases (P<.0001). Of the 3 sampling methods, the pulsatility index was abnormal in: (1) 19.2% (82/425) of cases when averaged from both umbilical arteries, (2) 22.1% (94/425) of cases when choosing 1 umbilical artery at random, and (3) 28.9% (123/425) of cases when the highest umbilical artery pulsatility index was used (P=.003).
Conclusion |
In this large fetal growth restriction cohort, the overall discrepancy between the 2 umbilical artery pulsatility indices was 11.7%. Among fetuses with at least 1 abnormal umbilical artery pulsatility index, 71 of 123 (57.7%) had 1 normal pulsatility index and 1 abnormal. Thus, the number of arteries sampled and the sampling method used may alter clinical decision-making, including frequency of surveillance and timing of delivery.
Le texte complet de cet article est disponible en PDF.Key words : Doppler velocimetry, fetal growth restriction, fetal surveillance, intrauterine growth restriction, umbilical artery
Plan
| The authors report no conflict of interest. |
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| The Perelman Family Foundation provided financial support for this project but did not have any role in the study design, collection of data, analysis, interpretation, writing, or decision to submit. |
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| This study was presented at the annual meeting of the Society for Maternal-Fetal Medicine, Grapevine, TX, February 3–8, 2020. |
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| Cite this article as: Steller JG, Driver C, Gumina D, et al. Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction. Am J Obstet Gynecol 2022;227:285.e1-7. |
Vol 227 - N° 2
P. 285.e1-285.e7 - août 2022 Retour au numéro
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