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Reappearance of End–Diastolic Velocities in the Umbilical Artery Following Maternal Volume Expansion: A Preliminary Study

Objective To determine the effects of maternal volume expansion on feto– and uteroplacental blood flow and neonatal outcome. Methods Seven women with pregnancies characterized by absent end–diastolic velocity in the umbilical artery were treated with bed rest, antihypertensive medication, and volume expansion (expanded group) and compared with seven similar cases treated with bed rest and antihypertensive medication (unexpanded group). Results In the expanded group, end–diastolic flow reappeared temporarily in all cases after volume expansion. The pulsatility index in the umbilical artery decreased from 2.69 (95% confidence interval [CI] 2.1–1.2) to 2.15 (95% CI 1.74–56) 24 hours after maternal volume expansion (P <001). All cases in the unexpanded group continued to demonstrate absent end–diastolic velocity. There was no significant difference between the groups with regard to birth weight, which was 773 g (95% CI 521–25) in the expanded group and 724 g (95% CI 429–19) in the unexpanded group (P=.76). The gestational age at delivery was not significantly different between the groups:203 days in the expanded group (95% CI 195–1) and 207 days in the unexpanded group (95% CI 189–225) (P=.71). The overall survival rate was significantly better in the expanded group: five of seven, versus one of seven in the unexpanded group (P <.05). Conclusions These preliminary data suggest that it is possible to improve feto–and uteroplacental perfusion with maternal volume expansion. The results point toward an improvement in neonatal outcome. Randomized trials are necessary to confirm our observations.