Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term

Abstract

ObjectiveTo evaluate the significance of fetal Doppler parameters in predicting adverse neonatal outcomes and the risk of cesarean delivery due to non-reassuring fetal status, in severe small for gestational age (SGA) fetuses of late preterm and term gestation.MethodsFetal brain and umbilical artery (UmA) Doppler parameters of cerebroplacental ratio (CPR) and UmA pulsatility index (PI) were evaluated in a cohort of 184 SGA fetuses between 34 and 41 weeks gestational age, who were less than the 5th percentile. The risks of neonatal morbidities and cesarean delivery due to non-reassuring fetal status were analyzed.ResultsUnivariate analysis revealed that abnormal CPR was significantly associated with cesarean delivery due to non-reassuring fetal status (P=0.018), but not with neonatal morbidities. However, abnormal CPR did not increase the risk of cesarean delivery due to non-reassuring fetal status in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA was associated with low Apgar score at 1 minute (P=0.048), mechanical ventilation (P=0.013) and cesarean delivery due to non-reassuring fetal status (P<0.001), in univariate analysis. It increased risk of cesarean delivery for non-reassuring fetal status (adjusted odds ratio, 7.0; 95% confidence interval, 1.2–41.3; P=0.033), but did not increase risk of low Apgar score or mechanical ventilation in multivariate logistic regression analysis.ConclusionAbnormal CPR with abnormal PI of UmA increases the risk of cesarean delivery for non-reassuring fetal status, in severe SGA fetuses of late preterm and term. Monitoring of CPR and PI of UmA can help guide management including maternal hospitalization and fetal monitoring.

Cerebroplacental Doppler Ratio in Prediction of Adverse Perinatal Outcome in Full Term Normal Pregnancy

“…In this study there are statistical significant connection between UA-PI and each of Apgar score at 1 minute and at 5 minutes that agree with Jo et al, [22] who studied 404 singleton gestations with small for gestational age embryos at late preterm and term, as well as 184 gestations with full doppler ultrasonography results in the UA and embryo MCA, and found that irregular UA-PI was linked to a low Apgar score (< 7) at 1 minute after birth. Our finding was disagree with Ale et al, study [10] who found no significant change in the Apgar scores at 1 and 5minute between fetuses with aberrant and normal UA-PI that may be due to the small sample size of their studied cases.…”

Management of isolated oligohydramnios in Korea: a questionnaire-based study of clinical practice patterns among the members of the Korean Society of Maternal Fetal Medicine

“…Given these considerations, until 35.6 weeks of gestation, conservative management is required. Further, until delivery, intensive fetal surveillances including fetal biophysical profile and Doppler analysis to evaluate placental dysfunction are needed [ 22 , 23 ]. In the KSMFM survey of 70 members in 2013, Oh reported that fetal surveillances were performed twice a week (20%), every week (43%) or every other week (35%), and 46% of respondents preferred induction after 37 gestational weeks in IO [ 24 ].…”

Comparative Study of Colour Doppler versus Non Stress Test as a predictor of Perinatal outcome in PIH and IUGR

“…In the study conducted by Jo et al caesarean section rate was 75% in abnormal Doppler velocimetry patients compare to 30% in normal Doppler study group which is almost corroborative with our study. 17…”