Retrograde flow in aortic isthmus - Trigger to deliver growth restricted
fetuses between 30-34 weeks of gestation?
Abstract
OBJECTIVE: To evaluate the association of aortic isthmus (AoI)
circulation assessed by doppler imaging in growth restricted fetuses
with perinatal outcome. DESIGN: prospective longitudinal observational
study. SETTING- Tertiary referral center POPULATION- Intrauterine growth
restriction (IUGR) (n=38) between 24–36 weeks’ gestation. METHODS-
Doppler examination in aortic isthmus, umbilical artery (UA), middle
cerebral artery(MCA), and ductus venosus(DV) was performed. The relation
between antegrade (n = 25) and retrograde flow (n = 13)in AoI ,other
Doppler parameters with perinatal outcome was analyzed. RESULTS:
Retrograde AOI group had higher rates of adverse perinatal outcome
(92.3% vs. 72%) with 63.1% sensitivity and 87.5% specificity.
Overall perinatal mortality (intrauterine death and neonatal death) was
higher in retrograde group (23%).No perinatal mortality in antegrade
AoI group. Cases with absent end diastolic flow (AEDF) or reverse end
diastolic flow (REDF) in the UA and retrograde flow in AoI and normal DV
flow had 40% prenatal mortality as 25% in those with abnormal DV
Doppler . CONCLUSION: Rretrograde blood flow in AoI is associated with
adverse perinatal outcome, particularly intrauterine demise, neonatal
death, RDS and increased duration of NICU stay. Even though the DV flow
is normal adverse outcome might be suspected in fetuses with AEDF/REDF
in UA and retrograde flow in AoI. Thus, retrograde flow in AoI might be
considered as an additional trigger for delivering IUGR fetuses 30-34
weeks with AREDF in UA but requires further evaluation by large
longitudinal studies . Keywords - Intrauterine growth restriction,
doppler ultrasonography; fetal aortic isthmus; perinatal outcome .