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Gestational Age at Delivery and Doppler Waveforms in Very Preterm Intrauterine Growth‐Restricted Fetuses as Predictors of Perinatal Mortality
Author(s) -
Mari Giancarlo,
Hanif Farhan,
Treadwell Marjorie C.,
Kruger Michael
Publication year - 2007
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2007.26.5.555
Subject(s) - medicine , gestational age , obstetrics , ductus venosus , middle cerebral artery , umbilical artery , odds ratio , fetus , confidence interval , pregnancy , population , vaginal delivery , cardiology , genetics , environmental health , ischemia , biology
Objective The aim of this study was to compare gestational age at delivery and the performance of middle cerebral artery (MCA), ductus venosus (DV), and umbilical artery Doppler parameters in the prediction of perinatal mortality and morbidity in intrauterine growth‐restricted (IUGR) fetuses delivered at 32 weeks or earlier. Methods The study population consisted of 41 patients with IUGR fetuses. Delivery occurred for maternal or fetal indications. Two‐tailed χ 2 and Fisher exact tests, an independent t test, and logistic regression were used for the analysis. P < .05 was considered statistically significant. Results Gestational age at delivery ranged between 23.1 and 32 weeks (median, 27.6 weeks). There were 17 perinatal deaths. Ninety‐four percent of the perinatal deaths occurred when the fetuses were delivered before 29 weeks. No fetus survived when delivered before 25 weeks. Two parameters predicted the perinatal mortality: gestational age at delivery (odds ratio, 0.52; 95% confidence interval, 0.31–0.88) and the combination of abnormal MCA peak systolic velocity + DV reversed flow (odds ratio, 10.2; 95% confidence interval, 1.8–57). For each week of pregnancy, there was a reduction in perinatal mortality of 48%. No Doppler parameters were significantly associated with perinatal morbidity. Conclusions Gestational age at delivery and the combination of abnormal MCA peak systolic velocity + DV reversed flow in very preterm IUGR fetuses were the best parameters in predicting perinatal mortality. The decreased perinatal mortality that is found for each week IUGR fetuses remain in utero should be taken into account when a decision to deliver an IUGR fetus before 30 weeks is made.