Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery
- 1Department of Paediatrics, Neonatal Unit, John Radcliffe Hospital, Oxford, UK
- 2Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital
- 3National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford, UK
- Correspondence to:
Dr A Johnson, National Perinatal Epidemiology Unit, Institute of Health Sciences, Old Road, Headington, Oxford OX3 7LF, UK;
ann.johnson{at}perinat.ox.ac.uk
- Accepted 20 December 2001
Abstract
Aim: To determine whether fetal compromise, manifested by abnormalities of Doppler recordings of umbilical artery velocity waveforms in utero, is associated with neurodevelopmental or educational abnormalities at school age.
Methods: A cohort of neonates born following high risk pregnancies had been previously identified for a study of the perinatal sequelae of absent (AEDFV) and reversed (REDFV) end diastolic flow velocities. Seventy six children were assessed at 5–12 years of age by a developmental paediatrician who was blinded to perinatal course and Doppler assessments. Forty children born following pregnancies with forward end diastolic flow velocities (FEDFV), were compared with 27 with AEDFV and nine with REDFV. Tests of cognitive, neurological, and sensory function were performed, and reports of behavioural and educational progress were obtained from parents and teachers.
Results: There were no significant differences between FEDFV and AEDFV groups, but on tests of mental ability and neuromotor function the REDFV group had worse scores than either FEDFV or AEDFV. Comparing REDFV and FEDFV groups, the British Ability Scales general conceptual ability mean scores were 87.7 versus 101, and the Quick Neurological Screening Test mean scores were 32.8 versus 21.5.
Conclusions: Absence of EDFV is well recognised as a marker of fetal compromise which is associated with acute perinatal sequelae. This study suggests it is not associated with adverse neurodevelopmental outcome. However, we found reversal of EDFV on antenatal assessment to be associated with a wide range of problems at school age, suggesting that REDFV represents intrauterine decompensation which may have adverse effects on the developing brain.
- AEDFV, absent end diastolic flow velocity
- AREDFV, absent or reversed end diastolic flow velocity
- BAS, British Ability Scale
- BP, blood pressure
- EDFV, end diastolic flow velocity
- FEDFV, forward end diastolic flow velocity
- GCA, general conceptual ability
- QNST, Quick Neurological Screening Test
- REDFV, reversed end diastolic flow velocity
- SDQ, Strengths and Difficulties Questionnaire
- SGA, small for gestational age
Footnotes
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Dr Hope died on 14 October 2001
