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Stumpfe FM, Faschingbauer F, Kehl S, Pretscher J, Stelzl P, Mayr A, Schild RL, Schmid M, Beckmann MW, Schneider MO. Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in small-for-gestational age fetuses at term. Arch Gynecol Obstet 2019; 300:575-581. [PMID: 31214775 DOI: 10.1007/s00404-019-05216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the association of short-term variation (STV) and Doppler parameters with adverse perinatal outcome in small-for-gestational-age (SGA) fetuses at term. METHODS In this retrospective single-center study 97 patients with singleton SGA fetuses at term (≥ 37 + 0 weeks' gestation) were examined. Inclusion criteria were a birth weight < 10th centile, cephalic presentation and planned vaginal birth. Only cases with available Doppler measurements of umbilical artery (UA) and middle cerebral artery (MCA) with calculated cerebroplacental ratio (CPR) in combination with a computerized CTG (cCTG) and STV 72 h prior to delivery were eligible for analysis. Pulsatility indices (PI) were converted into multiples of median (MoM), adjusted for gestational age. The association between Doppler indices and STV values with mode of delivery [secondary cesarean delivery (CD), operative vaginal delivery (OVD), as well as secondary CD and OVD due to fetal distress] and neonatal outcome [UA blood pH ≤ 7.15 and the need of admission to the neonatal intensive care unit (NICU)] was analyzed using logistic regression analysis. RESULTS There was a significant association between UA PI MoM and the rate of CD. CD due to fetal distress, OVD and OVD due to fetal distress did not show a correlation with the evaluated Doppler parameters. Furthermore, we did not find an association between low UA birth pH and Doppler parameters while neonates with the need of admission to NICU had significant higher UA PI MoM and significant lower MCA PI MoM and CPR MoM. Regarding STV, a significant effect of low STV on NICU admission was found while none of the other assessed outcome parameters were significantly associated with STV. CONCLUSION STV and Doppler parameters in SGA fetuses at term are significantly associated to the rate of NICU admission.
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Affiliation(s)
- Florian M Stumpfe
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany.
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
| | - Jutta Pretscher
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
| | - Patrick Stelzl
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Ralf L Schild
- Department of Obstetrics and Perinatal Medicine, Perinatalzentrum Hannover, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Matthias Schmid
- Department of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
| | - Michael O Schneider
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany
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Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in low-risk fetuses at term. Arch Gynecol Obstet 2018; 299:411-420. [PMID: 30511191 DOI: 10.1007/s00404-018-4978-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the association of short-term variation (STV) and Doppler parameters with adverse perinatal outcome in low-risk fetuses at term. METHODS This was a retrospective study of 1008 appropriate-for-gestational age (AGA) term fetuses. Doppler measurements [umbilical artery (UA), middle cerebral artery (MCA), and cerebroplacental ratio (CPR)] and computerized CTG (cCTG) with STV analysis were performed prior to active labor (≤ 4 cm cervical dilatation) within 72 h of delivery. The association between Doppler indices and STV values with adverse perinatal outcome was analyzed using univariate regression analysis. RESULTS No significant association between Doppler parameters and the need for secondary cesarean delivery (CD) or operative vaginal delivery (OVD) was shown. Regarding fetuses delivered by CD due to fetal distress, regression analyzes revealed significantly higher UA PI MoM. However, the differences in MCA PI MoM and CPR MoM were not statistically significant. Fetuses with the need for emergency CD showed significantly higher UA PI MoM, lower MCA PI MoM and lower CPR MoM. Neonates with a 5-min Apgar score < 7 had significantly lower MCA PI MoM and neonatal acidosis (UA pH ≤ 7.10) showed a significant association with UA PI MoM. None of the assessed outcome parameters were significantly associated to STV. CONCLUSION Doppler indices assessed close to delivery in low-risk fetuses at term show a moderate association with adverse outcome parameters, whereas STV does not appear to predict poor perinatal outcome in this group of fetuses.
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