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[Reverse flow in fetal vessels and perinatal events]
A K Ertan1, J P He, H-J Hendrik
1Universitäts-Frauenklinik und Poliklinik mit Hebammenlehranstalt, Homburg/Saar. ertan@uniklinuk-saarland.de
Zeitschrift Fur Geburtshilfe Und Neonatologie
|August 25, 2004
Summary
Reverse blood flow in fetal arteries indicates a high-risk pregnancy with poor outcomes. This condition is linked to placental insufficiency, increased fetal mortality, and potential cerebral lesions in newborns.
Area of Science:
- Perinatal medicine
- Fetal medicine
- Doppler ultrasonography
Background:
- Reverse flow in the umbilical artery/fetal aorta is linked to increased perinatal and neonatal mortality.
- A study compared 30 fetuses with reverse flow (Group I) to 30 controls with normal flow (Group II).
Purpose of the Study:
- To investigate the association between reverse arterial flow and pregnancy complications.
- To determine the prognostic significance of reverse flow in fetal circulation.
Main Methods:
- Pulsed wave Doppler sonography was used to identify reverse flow.
- Matched-pair analysis compared fetuses with reverse flow to controls with normal flow.
Main Results:
- Group I had significantly higher rates of pre-eclampsia, intrauterine growth retardation (IUGR), oligohydramnios, and nicotine abuse.
- Fetuses with reverse flow showed higher in utero mortality (40%), placental insufficiency (67%), and significantly lower postnatal pH values.
- Incidence of IUGR was 83% in Group I vs. 3% in Group II. Perinatal mortality was 27% in Group I vs. 0% in Group II.
- 50% of neonates with prenatal reverse flow had cerebral anomalies, and 28% of survivors had intracerebral hemorrhage (ICH).
Conclusions:
- Reverse arterial flow identifies a high-risk pregnancy group with a poor prognosis.
- Chronic placental insufficiency leading to IUGR is the primary cause of reverse flow.
- Cerebral lesions in affected fetuses are a critical factor in discussing perinatal outcomes with parents.