P10.25: Doppler, NST, and biophysical profile changes in severe IUGR—a longitudinal prospective randomized study

Timing longitudinal changes of umbilical artery, middle cerebral artery, umbilical vein, ductus venosus, and amniotic fluid index, up to delivery of IUGR fetuses with abnormal umbilical artery pulsatility index. A group of 145 fetuses with no maternal complications were followed by the time of diagnosis to cesarean delivery performed because of an abnormal biophysical profile or presence of repetitive decelerations. Doppler studies, NST, and biophysical profile, were initially performed every 4 days; they were repeated on a daily basis when the patients were admitted to the Hospital because of a cerebroplacental ratio < 1.0. There were 4 fetal demises and 50 neonatal deaths. Two IUGR groups were identified. Group A (n = 45) included fetuses in whom all Doppler parameters became abnormal and preceded an abnormal biophysical profile or abnormal NST. Group B included fetuses in whom one or more vessels were normal at the time of cesarean delivery. There was no difference in perinatal morbidity and mortality between the two groups. The only parameters that were associated to perinatal morbidity and mortality were umbilical artery reversed flow, ductus venosus absent/reversed flow and birth weight. Umbilical artery reversed flow and absence/reversed flow of the ductus venosus were present 7–8 days before an abnormal biophysical profile or an abnormal fetal heart rate test result. Low birth weight, umbilical artery reversed flow and ductus venosus absent/reversed flow are associated to an increased perinatal morbidity and mortality. Delivering the IUGR fetus in presence of umbilical artery reversed flow or ductus venosus absent/reversed flow in spite of normal biophysical profile and reassuring fetal heart rate, at less than 32 weeks, is probably not wise at the current time.