Doppler Findings in Intrapartum Fetal Distress
The umbilical vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CGT) and 26 fetuses with abnormal CTGs (GA>37w and cervical dilatation>3cm). Perinatal outcome was assessed according to presence or absence of UV pulsations. The 2 groups were similar regarding gestational age, cervical dilatation, Umbilical artery blood pH, S/D ratio,Pulsatility Index( PI) and Resistance Index (RI). Intraabdominal UV pulsation were present in 6 (23.1%) of abnormal CTG group but no case were seen in normal CTG group (P= 0.005). Five of 6 (83.3%) fetuses with UV pulsation underwent cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score
Gill RW, Trudinger BJ, Garrett WJ, Kossoff G, Warren PS. Fetal umbilical venous flow measured in utero by pulsed Doppler and B-mode ultrasound. I. Normal pregnancies. Am J Obstet Gynecol 1981;139(6):720-5.
Griffin D, Cohen-Overbeek T, Campbell S. Fetal and utero-placental blood flow. Clin Obstet Gynaecol 1983;10(3):565-602.
Baschat AA, Güclü S, Kush ML, Gembruch U, Weiner CP, Harman CR. Venous Doppler in the prediction of acidbase status of growth-restricted fetuses with elevated placental blood flow resistance. Am J Obstet Gynecol 2004;191(1):277-84.
Baschat AA. Fetal responses to placental insufficiency: an update. BJOG 2004;111(10):1031-41.
Rizzo G, Arduini D, Romanini C. Umbilical vein pulsations: a physiologic finding in early gestation. Am J Obstet Gynecol 1992;167(3):675-7.
Lingman G, Laurin J, Marsál K. Circulatory changes in fetuses with imminent asphyxia. Biol Neonate 1986;49(2):66-73.
Gudmundsson S, Huhta JC, Wood DC, Tulzer G, Cohen AW, Weiner S. Venous Doppler ultrasonography in the fetus with nonimmune hydrops. Am J Obstet Gynecol 1991;164(1 Pt 1):33-7.
Gudmundsson S, Gunnarsson GO, Hökegård KH, Ingemarsson J, Kjellmer I. Venous Doppler velocimetry in relationship to central venous pressure and heart rate during hypoxia in the ovine fetus. J Perinat Med1999;27(2):81-90.
Tulzer G, Gudmundsson S, Wood DC, Cohen AW, Weiner S, Huhta JC. Doppler in non-immune hydrops fetalis. Ultrasound Obstet Gynecol 1994;4(4):279-83.
Gudmundsson S, Tulzer G, Huhta JC, Marsal K. Venous Doppler in the fetus with absent end-diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol 1996;7(4):262-7.
Hofstaetter C, Gudmundsson S, Hansmann M. Venous Doppler velocimetry in the surveillance of severely compromised fetuses. Ultrasound Obstet Gynecol 2002;20(3):233-9.
Ghosh GS, Fu J, Olofsson P, Gudmundsson S. Pulsations in the umbilical vein during labor are associated with increased risk of operative delivery for fetal distress. Ultrasound Obstet Gynecol 2009;34(2):177-81.