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Objective: Absent or reverse end-diastolic flow(Doppler Ⅱ/Ⅲ)-in umbilical artery is correlated with poor perinatal outcome, particularly in intrauterine growth restricted(IUGR) fetuses. The optimal timing of delivery is still controversial. We studied the short-and long-term morbidity and mortality among these children associated with our defined management. Study design: Sixty-nine IUGR fetuses with umbilical Doppler Ⅱ/Ⅲ were divided into three groups; Group 1, severe early IUGR, no therapeutic intervention(n=7); Group 2, fetuses with pathological biophysical profile, immediate delivery(n=35); Group 3, fetuses for which expectant management had been decided(n=27). Results: In Group 1, stillbirth was observed after a mean delay of 6.3 days. Group 2 delivered at an average of 31.6 weeks and two died in the neonatal period(6%). In Group 3 after a mean delay of 8 days, average gestational age at delivery was 31.7weeks; two intrauterine and four perinatal deaths were observed(22%). Long-term follow-up revealed no sequelae in 25/31(81%) and 15/18(83%), and major handicap occurred in 1(3%) and 2 patients(11%), respectively, for Groups 2 and 3. Conclusion: Fetal mortality was observed in 22%of this high risk group. After a mean period of follow-up of 5 years, 82%of infants showed no sequelae. According to our management, IUGR associated with umbilical Doppler Ⅱ or Ⅲ does not show any benefit from an expectant management in term of long-term morbidity.
Objective: Absent or reverse end-diastolic flow (Doppler II / III) -in umbilical artery is correlated with poor perinatal outcome, particularly in intrauterine growth restricted (IUGR) fetuses. The optimized timing of delivery is still controversial. Study design: Sixty-nine IUGR fetuses with umbilical Doppler Ⅱ / Ⅲ were divided into three groups; Group 1, severe early IUGR, no therapeutic intervention (n = 7 ); Group 2, fetuses with pathological biophysical profile, immediate delivery (n = 35); Group 3, fetuses for which expectant management had been decided (n = 27). Results: In Group 1, stillbirth was observed after a mean delay of Group 2 delivered at an average of 31.6 weeks and two died in the neonatal period (6%). In Group 3 after a mean delay of 8 days, average gestational age at delivery was 31.7 weeks; two intrauterine and four perinatal deaths were observed (22%). Long-term follow-up revealed no sequelae in 25/31 (81%) and 15/18 (83%), and major handicap in 1 (3%) and 2 patients (11%), respectively, for Groups 2 and 3. Conclusion: Fetal mortality was observed in 22% of this high risk group. After a mean period of follow-up of 5 years, 82% of infants showed no sequelae. According to our management, IUGR associated with umbilical Doppler II or Ⅲ does not show any benefit from an expectant management in term of long-term morbidity.