Ultrasound can be used to detect placenta problems in small babies 

When a placenta malfunctions, the risk of a baby developing health problems or dying around birth increases. An ultrasound that measures blood flow in small unborn babies can reveal whether the placenta is working properly. If the ultrasounds repeatedly show abnormalities, then additional monitoring of the unborn baby is necessary.

This is according to the DRIGITAT study conducted by Amsterdam UMC together with UMCG, in which 17 other Dutch hospitals participated. The study was published today in the British Journal of Obstetrics & Gynaecology.

Doppler measurement 

About 10 per cent of unborn babies are smaller than normal for the gestational age. Pregnant people get growth ultrasounds to see how big the baby is. If a baby is small, the pregnant person will get ultrasounds more often to see if the baby is growing properly. In the DRIGITAT study, small babies were additionally given a Doppler measurement. This ultrasound measures the resistance of the blood vessel in the umbilical cord, which tells something about the blood flow to the placenta. The ultrasound can also measure the blood flow in the baby's brain. If this flow is higher than usual, this could be a signal that the placenta is not functioning properly. The baby has then "opened" the blood vessel in the brain an extra amount to protect the brain from the shortage caused by a malfunctioning placenta. With a placenta that functions inadequately, the risk of the baby developing health problems or, in rare cases, dying around birth increases.  

Higher risk better detection and monitoring 

Doppler measurements are not standard practice in all hospitals, but this study shows that they definitely add value when caring for undersized babies. With a Doppler measurement, the higher risk of problems around delivery can be better detected and monitored. Also, small babies in whom measurements are normal can be monitored somewhat less intensively. There is then also a greater chance that labour will proceed naturally, without intervention. 

No delivery earlier than 37 weeks 

The study also looked at whether it would be better for babies in whom the Doppler measurements showed abnormalities for labour to be induced before a gestational age of 37 weeks. This did not lead to better outcomes. The recommendation is to wait to induce labour until at least 37 weeks' gestation. This is because it is more beneficial for the baby to stay in the womb as long as possible, as long as there are no additional risks of health problems.

Cooperation with Amsterdam UMC 

The Obstetrics departments of Amsterdam UMC and UMCG are conducting a lot of research together to improve the care of babies who are (too) small for gestational age. Gynaecologist-perinatologist Wessel Ganzevoort of the Amsterdam UMCG and gynaecologist-perinatologist Sanne Gordijn of the UMCG together lead a group of scientists researching pregnancies in which there may be a poorer functioning placenta. In Drigitat study, Wessels Ganzevoort was the principal investigator (PI) and Sanne Gordijn was the co-PI.