Evaluation of the success of hemodilution therapy for fetal growth retardation by Doppler sonography

The aim of our study was to evaluate the success of a hemodilution therapy in patients with intrauterine growth retardation (IUGR) using Doppler sonography. Therefore, 22 patients with IUGR were subjected to hemodilution therapy using infusions of 500 ml hydroxyethylstarch in combination with 500 ml Ringer solution on 14 successive days. The 22 patients were divided into two groups on the basis of the actual birth weight, whereas 13 patients gave birth to an eutrophic infant (AGA group) while 9 infants remained dystrophic (SGA group). The following parameters were determined: hematocrit, prolongation of gestation, pulsatility and resistance index of the umbilical artery, the fetal aorta, the uterine arteries and the middle cerebral artery as well as the fetal outcome. Although the hematocrit decreases in both groups were almost identical, the Doppler sonographic examinations in the AGA group revealed in all cases more favorable improvements in perfusion under therapy in comparison with the SGA group. Considering the fetal aorta we could determine a worsening of perfusion in the SGA group. In the course of our investigations we have found that hemodilution therapy with hydroxyethylstarch represents a promising approach to counteract retarded fetal growth. Doppler sonography progress monitoring appears to be highly suitable for evaluating the response to therapy, especially since it can be assumed that the absence of an improvement in flow indicates only a slight advantage for the child.