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Absent umbilical arterial end-

diastolic flow
Definition
An 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.
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 as a
result of placental insufficiency 7-8.
• Flow in the umbilical artery(ies) should be in the
forward direction in normal circumstances. If
placental resistance increases, the diastolic flow
may reduce, later becoming absent and finally
reverses.
Associations
• Intra-uterine growth restriction (IUGR)
• Increased risk of neonatal thrombocytopenia
• Increased risk of necrotizing enterocolitis
Radiographic features
Doppler ultrasound
• The umbilical arterial velocity is seen reducing
to zero at end diastole.
• The impedance is found to be highest at the
fetal end of the umbilical cord and therefore
the absence of end diastolic flow is seen first
in this region
Treatment and prognosis
• The situation is associated with an increased
risk of fetal and neonatal mortality, as well as
an increased incidence of long-term
permanent neurologic damage.
• Approximately 1/3 of cases may improve with
bed rest. Often it is recommended that close
follow-up or expeditious delivery be pursued.
Reversal of umbilical arterial end
diastolic flow
• Reversal of umbilical artery end-diastolic flow
(REDF) or velocity is often an ominous finding
if detected after 16 weeks. It is classified as
Class III in severity in abnormal umbilical
arterial Dopplers.
Epidemiology
• The estimated incidence is at 0.5% of all
pregnancies with a much higher rate in
intrauterine growth-restricted (IUGR) fetuses.
Pathology
• The feature is seen as a result of a significant increase
in resistance to blood flow within the placenta and
often represents a "tip of the iceberg" where there is a
much larger underlying pathology.
• In a normal situation, umbilical arterial flow should
always be in the forward direction in both systole and
diastole.
• However, during the first 16 weeks, a reversal in end
diastolic flow can be a normal finding due to the low
resistance arcuate arteries and intervillous spaces not
yet being formed.
• Flow reversal can also be detected in the fetal aorta.
Radiographic features
• Ideally, a low wall filter setting (<100 Mhz) and
an acute insonation angle of <30% is
recommended.
• The severity can be quantified by the ratio of
the maximum antegrade velocity versus the
maximum retrograde velocity.
Treatment and prognosis
• It is associated with significant perinatal
mortality (27-64%) and overall mortality >50%
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.
2. Rochelson B. The clinical significance of absent end-diastolic velocity in the umbilical artery
waveforms. Clin Obstet Gynecol. 1989;32 (4): 692-702.
3. Forouzan I. Absence of end-diastolic flow velocity in the umbilical artery: a review. Obstet
Gynecol Surv. 1995;50 (3): 219-27.
4. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005)
ISBN:1588901475. Read it at Google Books
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.
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.
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
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.
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
10. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005)
ISBN:1588901475