Weekly and 2-week Doppler investigations to avoid misunderstanding compromised fetal conditions? SGA fetuses management in our experience

Fetal surveillance in adequate for gestational age (AGA) and small for gestational age (SGA) allows to predict distress conditions and improve neonatal outcome. Doppler velocimetry (DV), fetal heart rate monitoring (CTG), biophysical profile with amniotic fluid index, are the common tools used to have fetal direct–indirect signs of well-being. Several clinical studies stressed DV and CTG-like reliable evidences of fetal conditions, despite their known limitations, connected with gestational age and compensatory mechanisms. In order to establish the best follow up time for fetal health, we analyzed two different groups of 20 non-selected pregnant women with SGA 10–30 percentile. Intrauterine growth retardation were excluded for different role of DV in prediction and screening in placental disorders. From January to July 2001 we observed our two groups divided by maternal history; women were homogeneous for age and weight, with SGA. Diagnosis: Made at 20–24 weeks scan, according to most common used biometry diagrams. DV was performed on the main arterial districts by pulsatility index, in umbilical and middle cerebral artery, and peak velocity in intracardiac aorta, to estimate changes in blood flow velocity and cardiac out-put, to compare with Apgar index in neonatal outcome, including cesarean section rate. We closed our assessment with a precise definition of utility and applicability of weekly and 2-week follow up, in order to improve fetal conditions at delivery time, avoid misunderstanding fetal distress organize better work-time.