n South African Journal of Obstetrics and Gynaecology - Intrauterine deaths in high-risk pregnancies with normal and borderline umbilical artery Doppler flow velocity waveforms : research article

Volume 14, Issue 1
  • ISSN : 0038-2329
  • E-ISSN: 2078-5135



. To investigate the use of a personal computer (PC)-based, continuous-wave Doppler device by a trained midwife at the fetal evaluation clinic at a tertiary hospital to assess flow velocity waveforms (FVWs) of the umbilical artery flow in referred women.

. Pregnant women referred for suspected poor fetal growth were evaluated from June 2002 through December 2004. The Umbiflow device (still prototype, developed by CSIR / MRC / Stellenbosch University), consisting of a Pentium 3 PC with an ultrasound transducer plugged into the USB port, was used to analyse the FVW of the umbilical artery. Pregnancies in which the resistance index (RI) was < 75th percentile (&lt; P75) were not further evaluated for fetal well-being unless the clinical condition of the mother had changed. Pregnancies with an RI > P75 were followed up according to a specific protocol. Primary endpoints were intrauterine death and intrauterine growth restriction.
. Doppler FVWs were assessed in 955 pregnancies. The RI was < P75 in 529 participants (55.4%), between the P75 and P95 percentile in 350 (36.6%) and > P95 in 53 (5.5%). In 23 cases (2.4%) end-diastolic flow was absent or reversed (AREDF). Intrauterine death within 1 week of the test occurred in 1, 4, 0 and 2 women respectively in these four groups, and 16.7%, 34.5%, 54.9% and 65.5% respectively gave birth to infants that were small for gestational age.
. Intrauterine death, within 1 week of the test, was extremely rare when the RI was < P75 (0.2%). Relatively more deaths within a week of the Doppler examination occurred in the P75 - P95 group. This group should be regarded as being at high risk and needs careful antenatal surveillance.

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