Outcomes and Management of Pregnancies Complicated by Absent End-Diastolic Flow in the Umbilical Artery: A Retrospective Cohort Study

AbstractBackground/Aim: This study aimed to evaluate perinatal outcomes in pregnancies complicated by absent end-diastolic flow (AEDV) in the umbilical artery. Methods: This retrospective cohort study was conducted at Etlik City Hospital Perinatology Clinic from November 2022 to June 2024. Eighty-five pregnant women diagnosed with AEDF in the umbilical artery Doppler were included. Key outcomes, including fetal birth weight, gestational age at delivery, Apgar scores, NICU admissions, and perinatal morbidity and mortality, were assessed. Results: The mean gestational age at diagnosis and delivery was 28.86 ± 4.00 and 29.74 ± 3.85 weeks, respectively, with a median interval from AEDV detection to delivery of 2 days. The mean birth weight was 1031.42 ± 485.94 grams. A high cesarean delivery rate (89.4%) was observed, primarily due to fetal distress (63.2%). Fetal growth restriction (FGR) and preeclampsia were present in 80% and 38.8% of cases, respectively. Perinatal loss was 32.9%, with significant associations between higher hCG MoM levels and lower birth weight (r = -0.597, p = 0.011). ROC analysis indicated gestational age at delivery as the strongest predictor of neonatal complications (AUC: 0.804). NICU admissions showed severe neonatal complications, including intracranial hemorrhage and respiratory distress syndrome, aligning with the risk of poor outcomes in AEDV cases.Conclusions: AEDV in the umbilical artery is a significant predictor of adverse perinatal outcomes, including high perinatal mortality and neonatal complications. Early detection and careful monitoring, alongside timely delivery, are critical in managing these high-risk pregnancies to improve neonatal outcomes. Further research should focus on optimizing intervention timing to balance fetal maturity with the risks of prematurity.