How often is the finding of absent or reverse end diastolic flow in the umbilical artery associated with fetal IUGR or oligohydramnios?

Objective: Describe the association of absent or reverse end diastolic flow in the umbilical artery with current payor indications for the performance of pulsed Doppler assessment in the fetus.

Methods: We queried our single center database of 30,494 patients with a total of 58,176 examinations performed for all indications from the years 2000–2007. The center conducts all levels of fetal assessment. Our protocol is for every fetal exam to include detailed anatomical survey, with Doppler assessment of the fetus and maternal uterine arteries. Exams with absent or reverse end diastolic flow (AEDF, REDF) in the umbilical artery were identified and described.

Results: 27 singleton pregnancies with AEDF or REDF were found. 17/27 or 63%, had fetal IUGR (EFW <10th %ile) or oligohydramnios at the time of the abnormal umbilical artery Doppler. The distribution of gestational age at the time of detection of AEDF or REDF was 18 to 38.6 wks, with average 27.6 wks (SD 5.4). Of the 17 with concurrent IUGR or oligohydramnios, the average gestational age was 28.8 wks (SD 5.4), and 71% had a uterine artery Doppler pattern with diastolic notching. Of the 10 cases with no concurrent evidence of IUGR or oligohydramnios, the average gestational age was 25.7 wks (SD 5.0), and 4 had uterine artery diastolic notching, 3 had cardiac abnormality and 1 had a cranial abnormality. Overall, 74% of the total 27 cases identified had abnormal uterine artery diastolic notching.

Conclusions: Forty-seven percent of fetuses with absent or reverse diastolic flow of the umbilical artery did not have IUGR or oligohydramnios, the stipulated requirements for 3rd party reimbursement for this examination. Uterine artery diastolic notching was frequently noted in cases with abnormal umbilical artery Doppler of the fetus. This study suggests that Doppler examination of the umbilical artery after 24 weeks of gestation may be of benefit, irrespective of the initial fetal indication for the exam.

absent end-diastolic flow - fetal abnormalities - reverse end-diastolic flow - screening - umbilical artery doppler