Progression of Doppler changes in early-onset small for gestational age fetuses. How frequent are the different progression sequences?

Autores de IIS La Fe

• 

  José Morales Roselló

  Autor

• David Hervás Marín

  Autor

Participantes ajenos a IIS La Fe

• Khalil, A
• Fornes-Ferrer, V
• Alberola-Rubio, J
• Peralta Llorens N
• Perales-Marin, A

Grupos

• Medicina Reproductiva

  

  Investigador Principal

  José Morales Roselló

Abstract

OBJECTIVE: To evaluate the progression of Doppler abnormalities in early-onset fetal smallness (SGA). METHODS: A total of 948 Doppler examinations of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV), belonging to 405 early-onset SGA fetuses, were studied, evaluating the sequences of Doppler progression, the interval examination-labor at which Doppler became abnormal and the cumulative sum of Doppler anomalies in relation with labor proximity. RESULTS: The most frequent sequences were that in which only the UA pulsatility index (PI) became abnormal (42.1%) and that in which an abnormal UA PI appeared first, followed by an abnormal MCA PI (24.2%). In general, 71.3% of the fetuses followed the classical progression sequence UA-->MCA-->DV, mostly in the early stages of growth restriction (84.1%). In addition, the UA PI was the first parameter to be affected (9 weeks before delivery), followed by the MCA PI and the DV PIV (1 and 0 weeks). Finally, the UA PI began to sum anomalies 5 weeks before delivery, while the MCA and DV did it at 3 and 1 weeks before the pregnancy ended. CONCLUSIONS: In early-onset SGA fetuses, Doppler progression tends to follow a predictable order, with sequential changes in the umbilical, cerebral and DV impedances.

Keywords

• Early-onset fetal growth restriction; ductus venosus; fetal hemodynamics; fetal middle cerebral artery; small-for-gestational-age; umbilical artery