The role of Doppler indices in predicting intra ventricular hemorrhage and perinatal mortality in fetal growth restriction.

OBJECTIVES The aim of this study is to determine whether Doppler indices predict intra-ventricular hemorrhage and perinatal mortality in fetal growth restricted pregnancies (FGR). MATERIAL AND METHODS In this cohort study, 43 FGR fetuses underwent multi-vessel Doppler ultrasounds weekly or twice weekly after admission. Blood gases of the umbilical cord were analyzed immediately after delivery. Ultrasonography of the neonatal brain was performed after birth. Intra ventricular hemorrhage (IVH) and perinatal mortality were studied as outcomes. RESULTS The median gestational age at the diagnosis of fetal growth restriction was 31 weeks, and the median age at delivery was 33.4 weeks. Seven cases had IVH. The chance of IVH was about five times greater in cases of absent/reversed umbilical diastolic flow (AREDF). The predicting factors for IVH were gestational age at delivery, birth weight, and acidosis. Nine neonates died in the neonatal period. AREDF, the Resistance Index of middle cranial artery (MCA/RI) and umbilical artery (UA), and absent/reversed "a" waves in ductus venosus (DV) were the Doppler indices predicting perinatal mortality. The other prognostic factors for perinatal mortality were gestational age at diagnosis and delivery, final amniotic fluid, Apgar score, and acidosis. CONCLUSION Doppler indices, such as AREDF, can be predictors of IVH or perinatal death, and an absent or reversed "a" wave in the ductus venosus and the hypoxic index can be significant predictors of death in fetuses with fetal growth restriction. However, other important factors for IVH were gestational age at delivery and birth weight. The most important factors predicting perinatal mortality were gestational age, birth weight, acidosis, low AF, and low Apgar score.