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Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening.

Ute Feucht1,2, Tsakane Hlongwane3,2, Valerie Vannevel3,2

  • 1University of Pretoria, Pretoria, South Africa. ute.feucht@up.ac.za.

Global Health, Science and Practice
|November 4, 2022
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Summary

Continuous-wave Doppler ultrasound (CWDU) effectively screens low-risk pregnant mothers for fetal growth restriction, significantly reducing stillbirths and identifying infants at risk of poor postnatal growth in low- and middle-income countries.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Medical Ultrasound

Background:

  • Identifying high-risk fetuses in low-risk pregnant mothers is a critical but neglected research area.
  • Fetal growth restriction (FGR) is a major contributor to stillbirths, particularly in low- and middle-income countries (LMICs), and is often undetected in low-risk pregnancies.
  • Umbilical artery blood flow assessment using continuous-wave Doppler ultrasound (CWDU) can indicate placental function and detect FGR.

Purpose of the Study:

  • To evaluate the effectiveness of CWDU screening in identifying FGR and reducing stillbirths in a low-risk pregnant population in an LMIC.
  • To assess the postnatal growth outcomes of infants identified with abnormal umbilical artery blood flow via CWDU screening.

Main Methods:

  • A large-scale screening of over 7,000 low-risk pregnant mothers in an LMIC using CWDU to assess umbilical artery blood flow.
  • Implementation of a standard management protocol for pregnancies with abnormal placental blood flow detected by CWDU.
  • Follow-up assessment of infant body composition (fat-free mass) in early infancy.

Main Results:

  • A high prevalence of abnormal umbilical artery flow (13%) was found in the low-risk pregnant population, with 1.2% showing absent end-diastolic flow.
  • CWDU screening combined with a management protocol led to a 43% reduction in stillbirths.
  • Infants identified with abnormal umbilical artery blood flow exhibited significantly reduced fat-free mass postnatally, confirming FGR detection.

Conclusions:

  • CWDU is an inexpensive and effective tool for screening low-risk pregnant populations in LMICs for fetuses at risk of stillbirth and FGR.
  • Screening with CWDU can lead to a significant reduction in stillbirth rates.
  • CWDU screening identifies infants likely to experience suboptimal growth and development, enabling timely intervention.