eISSN: 2449-6731
ISSN: 2449-6723
Prenatal Cardiology
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Original paper

Interartery discordance in fetuses with growth restriction

John W. Ross
A. Dhanya Mackeen
Alexandria Betz
Wen Feng
Jay J. Bringman
Michael J. Paglia

  1. Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville, Pennsylvania, 17821 USA
Prenat Cardio 2018 Jan; 8(1):42-47
Online publish date: 2019/07/16
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Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes.

This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality.

Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03).

The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.


fetal growth restriction, umbilical artery systolic/diastolic ratios, estimated fetal weight, discordance

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