[Value of Doppler velocimetry of the umbilical artery, aorta, cerebral artery, and uterine artery in pathological pregnancies]

Abstract

This prospective study try to evaluate the predictive value of Doppler umbilical artery in the diagnosis of intra-uterine retardation (IUGR) and fetal distress requiring operative delivery. We use the blood flow class (BFC) to characterize the blood velocity waveform. Like others, we found a strong negative correlation between the blood flow class and fetal weight at delivery. When the umbilical BFC is abnormal in case of suspicion of IUGR, the diagnosis is confirmed at delivery in 100%, but in case of umbilical BFC 0, we found only 53% of IUGR. If we consider the mode of delivery, we found 7% of cesarean section for fetal distress in BFC 0, 38% in BFC1 and 78% in BFC 2-3. We had 5 fetal death, two cases with malformations, non-immunologic hydrops and trisomy 18. The others three were severe IUGR, in all cases the umbilical Doppler BFC was abnormal. Another parameter was significantly modified in case of fetal distress: the cerebro-placental index. This confirm the brain sparing phenomenon. We found a prevalence of IUGR of 43% in the high risk pregnancies group. The positive predictive value of umbilical Doppler is 82%, but the sensitivity is low, 44%. The efficacy of umbilical Doppler to predict the occurrence of operative delivery for fetal distress is better, because the prevalence is lower, 18%, the positive predictive value is 60% and the sensibility 70%. There is non doubt that, fetal blood flow is a secondary test of great value in identifying fetuses at risk of perinatal hypoxia.