Cerebroplacental ratio in prediction of adverse perinatal outcome and fetal heart rate disturbances in uncomplicated pregnancy at 40 weeks and beyond.

INTRODUCTION: The aim of the study was to determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond. MATERIAL AND METHODS: One hundred and forty-eight women in uncomplicated pregnancies, between 40 and 42 completed weeks, were divided into control and study groups: with the absence (n = 79) and with the presence of a fetal brain-sparing effect (n = 69), respectively. Pulsatility and resistance indices in the middle cerebral, the umbilical artery and the C/U ratio were evaluated daily by Doppler ultrasonography. C/U < 1.1 was reported as suggestive of a brain-sparing effect. Abnormal flow indices were analyzed and compared to adverse pregnancy and neonatal outcome determinants. RESULTS: In the abnormal C/U group the abnormal CTG records were significantly more frequently observed (62.3%) than in normal C/U group (19.0%) (p = 0.0001). The comparison of selected Doppler indices revealed that C/U showed the highest sensitivity in prediction of both the intrapartum abnormal FHR (74.1%) and the adverse neonatal outcome (87.8%). CONCLUSIONS: The C/U index shows the highest sensitivity in prediction of FHR abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond. The C/U index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

Hypoxia index in the prediction of abnormal CTG at delivery in uncomplicated pregnancies.

OBJECTIVES: The evaluation of hypoxia index (HI) in the prediction of abnormal fetal heart rate at delivery in uncomplicated pregnancies. MATERIAL AND METHODS: The study group included 148 pregnant patients at term (69 patients with and 79 without brain sparing effect). The value of C/U ratio and HI was determined. Next, its value in predicting abnormal fetal heart rate during labor was evaluated. Then the predictive value of the HI index, C/U and last abnormal values of PI and RI in the MCA and the UA were compared in relation to the analyzed parameters. Evaluation included signs of fetal distress in CTG and abnormal fetal outcome. Then selected parameters, characterizing pregnancy course and fetal outcome with abnormal Doppler indices, were compared. RESULTS: The designated value of hypoxia index characterized by abnormal neonatal outcome was >10 for sHI and >14 for HI. Low prognostic value of MCA PI and RI, and UA PI and RI has been shown. The highest predictive value was marked by C/U and HI. There were no statistically significant differences in prediction of abnormal fetal heart rate during labor between C/U ratio, HI and sHI. CONCLUSIONS: The C/U ratio showed the highest sensitivity in the prediction of fetal abnormal heart rate. The C/U ratio, as a easier test, should be recommended as a first-line test in the prediction of abnormal CTG recordings in uncomplicated pregnancies.

[Doppler blood flow velocimetry in the umbilical artery in uncomplicated pregnancy]. / Ocena przeplywu krwi w tetnicy pepowinowej w ciazy prawldlowej jako predykcia zaburzen czynnosci serca plodu w czasie porodu.

OBJECTIVE: To determine the resistance index (RI) and pulsatility (PI) in the umbilical artery (UA) in prediction of abnormal fetal heart rate during labor and poor fetal outcome in term pregnancy. MATERIAL AND METHODS: The study included 148 patients at term in uncomplicated pregnancy Daily evaluation of blood flow in the UA was performed and PI and RI were calculated. The last value before delivery was taken for the analysis. In turn predictive value of Doppler parameters has been determined in the prediction of abnormal FHR during labor and abnormal newborn condition. Evaluation included fetal CTG parameters and newborn status based on the V.Apgar scale and acid-base equilibrium in the umbilical cord blood. Then selected parameters, characterizing pregnancy and the newborn status, with abnormal Doppler results were compared. The prognostic value of Doppler indices was assessed for selected parameters determining the course of pregnancy and abnormal fetal heart rate. RESULTS: A poor predictive value of UA PI and RI in the prediction of abnormal fetal heart rate during labor and poor fetal outcome was found. The RI in the UA presented the highest predictive value. CONCLUSION: RI in the UA shows higher predictive value than PI in the detection of abnormal fetal outcome and abnormal fetal heart rate in uncomplicated pregnancy at term. However, PI as well as RI in the UA have a low predictive value for the analyzed parameters.

[Doppler blood flow velocimetry in the middle cerebral artery in uncomplicated pregnancy]. / Ocena przeplywu krwi w tetnicy srodkowej mózgu w ciazy niepowiklanej.

OBJECTIVE: To determine the resistance index (RI) and pulsatility (PI) in the middle cerebral artery (MCA) in prediction of abnormal fetal heart rate during labor and poor fetal outcome in term pregnancy. MATERIAL AND METHODS: The study included 148 patients at term in uncomplicated pregnancy Daily evaluation of blood flow in the MCA was performed and PI and RI were calculated. The last value before delivery was taken for the analysis. The predictive value of Doppler parameters has been determined in turn to predict abnormal FHR during labor and abnormal newborn condition. Evaluation included fetal CTG parameters and newborn status based on the V Apgar scale and acid-base equilibrium in the umbilical cord blood. Then selected parameters, characterizing pregnancy and the newborn status, were compared with abnormal Doppler results. The prognostic value of Doppler indices was assessed for selected parameters determining the course of pregnancy and abnormal fetal heart rate. RESULTS: Poor predictive value of UA PI and RI in the prediction of abnormal fetal heart rate during labor and poor fetal outcome was found. The RI in the UA presented the highest predictive value. CONCLUSION: PI in the MCA shows higher predictive value than RI in the detection of abnormal fetal outcome and abnormal fetal heart rate in uncomplicated pregnancy at term. However PI indices, particularly RI in the middle cerebral artery have low predictive value for the analyzed parameters.