Absent or reversed end diastolic flow in the umbilical artery during fetal spina bifida repair: is the postoperative CTG or the perinatal or neurodevelopmental outcome at 2 years of age affected?

Introduction Absent or reversed end diastolic flow (AREDF) in the umbilical artery (UA) Doppler are common phenomena during fetal interventions such as fetal spina bifida (SB) repair. However, the clinical importance of these Doppler findings and especially the impact on children"s outcome is not yet conclusively clarified.

Therefore, the main goals of this study were to evaluate whether an AREDF-UA during the SB repair has an influence on the postoperative CTGs or the perinatal or neurodevelopmental outcome at 2 years of age.

Patients and Methods Between December 2010 and November 2019 132 patients underwent SB repair at our center. The pre-, intra- and postoperative ultrasound data was reviewed for AREDF-UA. The group with AREDF-UA was compared to the group with normal UA Doppler. The primary endpoint was the FIGO-Score of the CTGs 1, 2 and 6 hours postoperatively. Secondary endpoints were the perinatal outcome with gestational age at delivery, UA-pH, Apgar score and birth weight and the children's neurodevelopmental outcome at 2 years of age using the motor, cognitive and language composite scale of the Bayley scale III of infant development. At the time of writing the Bayley scale III of infant development at age 2 was available for 78 children.

Results None of the fetuses showed AREDF before SB repair. In 13 (10%) patients an AREDF and in 116 (88%) a normal UA-Doppler was observed during or immediately after SB surgery. Hereof, 9 (7%) cases showed an AEDF-UA and 4 (3%) cases a REDF. On the first day after SB-surgery the AREDF disappeared in all 13 cases. We observed that the CTGs were restricted in almost a third of all cases (N=39). Neither the frequency of a restricted CTG nor the FIGO-score at 1, 2, 6 hours and the first postoperative day was significantly different between the two groups (p=0.11).

Additionally GA at delivery (AREDF: 35.5 ± 2.4 vs. normal UA-Doppler: 35.5±2.1 weeks, p=0.94), pH (AREDF: 7.33±0.04 vs. normal UA-Doppler: 7.33±0.10, p=0.85), 5 minute APGAR (AREDF: 8±1 vs. normal UA-Doppler: 8±1, p=1.0) and birth weight (AREDF: 2445±449 vs. normal UA-Doppler: 2596±510 g, p=0.31) were comparable between both groups.

Furthermore, there was no significant difference of the motor, cognitive and language composite scale of the Bayley scale III between both groups (motor: p=0.30, cognitive: p=0.62, language: p=0.50).

Conclusion The postoperative CTGs after a short-term AREDF-UA during SB-repair recover similarly as in normal UA-Doppler cases. An AREDF-UA compared with a normal UA-Doppler did not negatively influence the perinatal or neurodevelopmental two years outcome of the children.

Publication History

Article published online:
26 November 2021