Clinical relevance of fetal hemodynamic monitoring: Perinatal implications

Fetal Surveillance in High-Risk Fetal Cardiac Disease: Frequency, Results and Relationship with Survival

OBJECTIVES

We hypothesized that pregnancies with high-risk fetal heart disease (FHD) would benefit from frequent prenatal surveillance, abnormal fetal surveillance results would be associated with worse outcomes, and cardiovascular profile scoring (CVPS) could identify FHD cases at highest risk of death.

METHODS

A retrospective single-centre study of all actively treated pregnancies with high-risk FHD from 2006-2020. Frequency and results of fetal surveillance, survival, and mode of delivery were collected. Frequent fetal surveillance was defined as ≥ once weekly fetal wellbeing testing commencing by 28-32 weeks of gestation, or from later diagnosis, until delivery. Where possible, the CVPS was calculated.

RESULTS

Fetal surveillance results were available in 92% (56/61) of pregnancies with high-risk FHD and were abnormal in 18% (10/56). A final CVPS of ≤7 carried a higher mortality (11/21, 52%) than ≥8 (6/31, 19% (P = 0.01)). There was a trend toward worse survival at last follow-up when fetal surveillance was abnormal versus normal (40%, 4/10 vs 72%, 33/46, P = 0.07). Survival did not differ between frequent versus infrequent surveillance (13%, 4/30 vs 3%, 1/31, P = 0.20); nor when comparing abnormal versus normal surveillance results (20%, 2/10 vs 7%, 3/46, P = 0.21). Where fetal surveillance was abnormal, emergency cesarean delivery was more common (70%, 7/10 vs. 4%, 2/46, P < 0.001).

CONCLUSION

Abnormal fetal surveillance results and/or a CVPS ≤7 may identify compromised fetuses with high-risk FHD who could benefit from altered management or expedited delivery. Given the high rates of abnormal fetal surveillance in high-risk FHD, frequent fetal surveillance in the third trimester should be considered.

Association Between Fetal Middle Cerebral Artery and Umbilical Artery Doppler Ratio with Fetal Distress in 38-40 Weeks of Gestation

BACKGROUND AND OBJECTIVE

Knowing the factors affecting fetal distress is of particular importance in improving prognosis in newborns. The study aimed to determine the relationship between fetal middle cerebral artery pulsatility indexes and umbilical artery Doppler ratio with fetal distress at 38-40 weeks of gestation.

MATERIALS AND METHODS

In this prospective cohort, 181 consecutive pregnant women with 38-40 weeks of gestational age were selected by a non-random convenience sampling method from January 2016 to January 2017. Women with labor pain and embryos with chromosomal and structural disorder were excluded. Color Doppler sonography was done for all of them, and the association of this ratio with fetal distress consequently was assessed as well.

RESULTS

In this study, abnormal amniotic fluid index (AFI) (1.1%), low birth weight (< 2500 g) (5.5%), emergency cesarean (11.6%), neonatal intensive care unit (NICU) admission (12.2%), low 5th minute Apgar (< 7) (0.6%), abnormal fetal monitoring (10.5%), fetal distress (11.6%), meconium aspiration syndrome (10.5%), and respiratory distress (3.9%) were present. The mean cerebroplacental ratio was 1.9. There was a significant association between low fetal middle cerebral artery pulsatility index and umbilical artery Doppler ratio with fetal distress, abnormal monitoring, and urgent cesarean (P = 0.006). The cutoff 1.94 led to sensitivity, specificity, positive predictive value, and negative predictive value of 80.95, 50, 17.5, and 95.2%, respectively.

CONCLUSION

It may be concluded that in our study a cutoff for fetal middle cerebral artery to umbilical artery ratio of 1.94 at 38 weeks was considered statistically significant in predicting fetal distress at 38-40 weeks. However, further studies with larger sample size and multi-center sampling would develop more definite results for wider application.