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Absent umbilical arterial end diastolic flow

Dr Abhilash Sandhyala and Dr Yuranga Weerakkody et al.

An absent end diastolic flow (AEDF) in the umbilical artery Doppler assessment is a useful feature which indicates underlying fetal vascular stress if detected in mid or late pregnancy. It is often classified as Class II in severity in abnormal umbilical arterial Dopplers ⁹.

Pathology

The presence of absent end diastolic flow (AEDF) can be normal in early pregnancy (up to 16 weeks). In mid to late pregnancy it usually occurs from placental insufficiency ^7-8. Flow in the umbilical artery(ies) should be in the forward direction in normal circumstances. If the placental resistance increased for some or other reason, the diastolic flow may reduce, then become absent and finally go into reverse.

Associations

intra-uterine growth restriction (IUGR)
increased risk of neonatal thrombocytopaenia ⁶

Radiographic features

Doppler ultrasound

The umbilical arterial velocity is seen reducing to zero at the end of diastole.

Treatment and prognosis

The situation carries an increased fetal and neonatal mortality as well as an increased incidence of long-term permanent neurologic damage ⁵.

Approximately a 3^rd of cases may improve with bed rest. Often it is recommended that close follow-up and / or expeditious delivery should be contemplated ⁷.

References

1. Adiotomre PN, Johnstone FD, Laing IA. Effect of absent end diastolic flow velocity in the fetal umbilical artery on subsequent outcome. Arch. Dis. Child. Fetal Neonatal Ed. 1997;76 (1): F35-8. Arch. Dis. Child. Fetal Neonatal Ed. (link) - Free text at pubmed - Pubmed citation
2. Rochelson B. The clinical significance of absent end-diastolic velocity in the umbilical artery waveforms. Clin Obstet Gynecol. 1989;32 (4): 692-702. - Pubmed citation
3. Forouzan I. Absence of end-diastolic flow velocity in the umbilical artery: a review. Obstet Gynecol Surv. 1995;50 (3): 219-27. Obstet Gynecol Surv (link) - Pubmed citation
4. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
5. Valcamonico A, Danti L, Frusca T et-al. Absent end-diastolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am. J. Obstet. Gynecol. 1994;170 (3): 796-801. - Pubmed citation
6. Baschat AA, Gembruch U, Reiss I et-al. Absent umbilical artery end-diastolic velocity in growth-restricted fetuses: a risk factor for neonatal thrombocytopenia. Obstet Gynecol. 2000;96 (2): 162-6. - Pubmed citation
7. Wang KG, Chen CY, Chen YY. The effects of absent or reversed end-diastolic umbilical artery Doppler flow velocity. Taiwan J Obstet Gynecol. 2009;48 (3): 225-31. doi:10.1016/S1028-4559(09)60294-1 - Pubmed citation
8. Battaglia C, Artini PG, Galli PA et-al. Absent or reversed end-diastolic flow in umbilical artery and severe intrauterine growth retardation. An ominous association. Acta Obstet Gynecol Scand. 1993;72 (3): 167-71. - Pubmed citation
9. Gerber S, Hohlfeld P, Viquerat F et-al. Intrauterine growth restriction and absent or reverse end-diastolic blood flow in umbilical artery (Doppler class II or III): A retrospective study of short- and long-term fetal morbidity and mortality. Eur. J. Obstet. Gynecol. Reprod. Biol. 2006;126 (1): 20-6. doi:10.1016/j.ejogrb.2005.07.008 - Pubmed citation
10 .Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon