Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler?

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Abstract
Objective: To evaluate relationships between neonatal intraventricular hemorrhage and altered brain blood flow in preterm growth‐restricted fetuses.Methods: One hundred and thirteen growth‐restricted fetuses (birth weight two standard deviations above gestational age mean) which delivered prematurely ( two standard deviations below the gestational age mean, ‘centralization’ = ratio of middle cerebral artery/umbilical artery pulsatility indices (cerebroplacental ratio) > two standard deviations below the gestational age mean, and ‘redistribution’ = absent or reversed umbilical artery end‐diastolic velocity. Intraventricular hemorrhage was graded after Papile (I–IV) by cranial ultrasound performed within 7 days of delivery.Results: Sixty‐seven (59.3%) fetuses had brain sparing, 84 (74.3%) had centralization and 51 (45.1%) had redistribution. Fifteen (13.3%) neonates had intraventricular hemorrhage and were more likely to have a biophysical profile 3, hemoglobin, and platelets, a 10‐min Apgar score P < 0.005). Multiple logistic regression revealed significant associations between intraventricular hemorrhage and a low 10‐min Apgar score (r = 0.30, P < 0.005) and low hemoglobin (r = 0.28), gestational age at delivery (r = 0.25) and birth‐weight centiles (r = 0.23) (P < 0.05). No Doppler parameter was identified as an independent contributor to intraventricular hemorrhage.Conclusion: While loss of umbilical artery end‐diastolic velocity early in gestation significantly increases the risk for neonatal intraventricular hemorrhage, prematurity and difficult transition to extrauterine life remain the most important determinants of intraventricular hemorrhage. Copyright © 2002 ISUOG