In 110 pregnancies, repeated examinations of unconjugated E3 and HPL levels in maternal serum were carried out as well as repeated duplex pulsed doppler flow measurements in the umbilical artery and the fetal aorta. In 30 cases the fetuses were suspected to be growth retarded (group A), 5 small for date babies were not detected by routine ultrasound (group B) and 75 were normal control cases (group C). 17 fetuses of group A proved to be really SGA-babies (birthweight less than 10. percentile). The evaluation of the results indicates a higher sensitivity of the flow measurements in the diagnosis of growth retardation compared with the hormonal parameters (flow: 65%, E3: 12%, HPL: 29%). Above all, Doppler sonography is very reliable in distinguishing between growth retarded fetuses, at risk or not at risk.
Rising Caesarean section (CS) rates worldwide have raised concerns regarding indications such as breech presentation in term singletons. Studies have shown advantages for CS in unselected populations. Criteria to select candidates for a trial of labour (TOL) are needed. 2 years ago, we reported a high specificity of Doppler regarding the risk for urgent CS in small for gestational age (SGA) fetuses. Recently a large Finnish population-based cohort study identified oligohydramnios as a risk factor for adverse perinatal outcome. We tried to decide the role of oligohydramnios compared to materno-fetal Doppler in selecting candidates among this population. From 2009 to 2017, 82 term breech babies with birth weight at 10thcentile or less but no malformation underwent a TOL at our department. Median gestational age was 39+2 weeks. 73/82 pregnancies had at least one Doppler examination; roughly half of more than one parameter (ACM or uterine artery (UtA) in addition to umbilical artery (UA)). In 80/82 cases AF was documented. In this study, we compared estimated fetal weight, original Doppler findings and AF to the obstetrical and neonatal outcomes. 67 deliveries (81.7%) were completed vaginally. 15 had to be finished by timely Caesarean, 11 for signs of fetal distress and 4 for other indications (footling presentation, failure to progress). 6 fetuses had shown pathological Doppler findings (2x UmbA-PI >95%, 4x UtA-PI bilaterally >95%). 4/6 had to be delivered by urgent CS. In our cohort, oligohydramnios was positively correlated with vaginal birth (RR for CS 0.96). 7 babies needed NICU care for distress. No birth injuries or long-term morbidity were observed. Doppler ultrasound can improve the safety of vaginal breech delivery by facilitating selection of fetuses with normal flow who are by definition not growth restricted. Cases with pathological findings should be excluded from TOL. Doppler pathology appears to be a stronger risk factor for poor outcome than oligohydramnios which on its own should not be an indication for CS. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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