Intermittent absent end diastolic velocity of the umbilical artery: Antenatal and neonatal characteristics and indications for delivery

Objective: To check whether there is a difference in indications for delivery, antepartum and neonatal characteristics in intermittent absent end diastolic velocity (iAEDV) compared to persistent absent or reversed end diastolic velocity (pA/REDV). Methods: A retrospective study of 109 patients with iAEDV or pA/REDV from 19 to 39 weeks. The delivery indication was classified as maternal or fetal. The primary antepartum and maternal characteristics were age, parity, AMA, chronic hypertension, PEC, thrombophilia, lupus, diabetes, smoker, placenta previa, gestational age (GA) at diagnosis of IUGR and/or SGA, GA at diagnosis of elevated S/D, iAEDV or pA/REDV, GA at delivery, minimal/absent variability day of delivery, BPP≤6 prior to delivery. The primary neonatal outcomes were birth weight, arterial cord pH, neonatal demise, necrotizing enterocolitis, intraventricular hemorrhage and length of stay in the NICU. Results: Fetuses with iAEDV were diagnosed with an elevated S/D at a later GA (29.6 vs. 27.5 weeks, p<0.03), delivered at a later GA (31.6 vs. 29.7 weeks, p<0.01), had a higher birth weight (1336.6 vs. 933g, p<0.0004), were more likely to be delivered for maternal indications (42.9% vs. 20.27%, p<0.01), had a higher cord arterial pH (7.28 vs. 7.21, p<0.002) and were less likely to have an arterial pH at birth <7.2 (0% vs. 34.1%, p<0.002). Conclusions: Although fetuses with iAEDV have an improved antenatal course as compared with pA/REDV, indications for delivery are more likely to be maternal and adverse outcome is common.