The significance of visualising coronary blood flow in early onset severe growth restricted fetuses with reverse flow in the ductus venosus

Objective. To evaluate the incidence and significance of coronary blood flow visualisation in early onset severe intrauterine growth restriction (IUGR) fetuses and to assess its relationship with the presence of reverse flow in ductus venosus (DV). Methods. The examination of coronary artery was performed at a gestational age < 26 weeks in 19 IUGR fetuses from mothers without medical complications and characterised by the presence of reverse flow in DV. Visualisation or non-visualisation of coronary circulation were compared with fetal and neonatal outcome. Results. Coronary flow was seen in 7/19 (36.8%) of the IUGR fetuses and these fetuses showed a higher incidence of fetal death (71.4% vs. 16.6%, p = 0.044), delivery or fetal death at an earlier gestational age (23.71 vs. 26.57 weeks, p = 0.011) and a lower birthweight (310 vs. 586 g, p = 0.011). Kaplan-Meier survival analysis demonstrated that visualisation or non-visualisation of coronary flow in such fetuses provides an independent contribution in the prediction of the time interval between Doppler study and delivery or fetal death (chi square = 15.36, p < 0.001). Conclusions. Visualisation of coronary flow in IUGR fetuses with reverse flow in the DV identifies a subgroup of fetuses with a poorer fetal and neonatal outcome.