Abstract
Introduction Fetal growth restriction (FGR) is associated with perinatal morbidity, acidosis, and adverse neurological outcomes. While arterial Doppler of the umbilical artery (UA) and middle cerebral artery informs surveillance, ductus venosus (DV) Doppler may better reflect central hemodynamics and impending cardiac decompensation. This study evaluated the predictive value and clinical significance of DV Doppler velocimetry for acid-base status, early postnatal Apgar score (AS), neonatal morbidity, and neurological outcomes in infancy. Methods In a retrospective, single-center cohort, pregnancies with and without FGR underwent UA and DV Doppler assessment. DV waveforms were classified as normal or pathological based on the presence of an absent or a reversed A-wave. Neonatal outcomes included umbilical artery blood pH, AS at standard early postnatal intervals, composite neonatal morbidity, and neurological status during the early neonatal period and later infancy. Associations were examined using Fisher's exact tests, and diagnostic performance was summarized with sensitivity, specificity, positive predictive value, and negative predictive value. Results A pathological DV was recorded in 15.4% of fetuses with FGR. In this subgroup, acidosis (pH <7.20) occurred in 100% of cases and was significantly less frequent among fetuses with normal DV findings (p <0.001). At one minute, a low AS (0-3) was present in 75% of newborns with pathological DV, and at five minutes in 25%; all newborns with pathological DV had an AS of ≤7 at both time points, whereas an AS of ≥7 predominated in the normal DV group (p <0.01). Neonatal morbidity was present in 100% of newborns with pathological DV compared with 29.5% in the normal DV group (p <0.001). During the first month, all newborns with pathological DV demonstrated neurological injury on early assessment. Conclusion DV Doppler adds clinically actionable information to arterial Doppler in FGR by identifying venous decompensation at a stage when intervention may alter outcome. Incorporating DV evaluation into routine surveillance can trigger timely delivery when venous compromise is present and support expectant management when venous flow remains normal, helping clinicians balance the risks of prematurity against progressive hypoxic-ischemic injury and may inform perinatal care pathways.