Impact of reverse end-diastolic flow velocity in umbilical artery on pregnancy outcome after the 28th gestational week

Background: The aim of this study was to discuss pregnancy outcome in chromosomally and structurally normal fetuses having reverse end-diastolic flow velocity (REDFV) on Doppler umbilical artery velocimetry (DUAV) in the third trimester. Methods. DUAV was performed in the high risk pregnancy antepartum fetal surveillance. We excluded gestational age less than 28 weeks, multiple pregnancies, and chromosomal or congenital anomalies. Thirty cases were categorized as having REDFV. The pregnancy outcome was investigated in these cases. Results. There were three stillbirths and 12 neonatal deaths, resulting in a perinatal mortality rate of 50%. Twenty-eight patients (93.3%) had complications with preeclampsia (20 of severe degree and eight moderate). Cesarean section was performed on 24 patients (80%) due to acute fetal distress. The mean gestational age at delivery was 31.8 ± 3.2 weeks. The mean diagnosis-to-delivery interval was 10 ± 8.2 hours. The average birth weight was 970 ± 270 gm, 28 (93.3%) were found to be below the 10th percentile of ideal birth weight. An umbilical artery pH less than 7.2 at delivery was found in 12 of 18 examined cases (66.7%). Twelve out of 15 placentae (80%) showed significant infarcts on pathological examination. All newborns (100%) needed admission to the neonatal intensive care unit. Conclusions. REDFV on DUAV represents an ominous and severe fetal condition with an adverse pregnancy outcome, especially in conditions associated with preeclampsia and/or intrauterine growth retardation. Intensive and frequent surveillance and aggressive management at the appropriate time would improve perinatal outcome.