Affiliation:
1. Universidade de São Paulo, Brazil
2. Universidade Federal de São Paulo, Brazil; Universidade Municipal de São Caetano do Sul, Brazil
3. Universidade Federal do Triângulo Mineiro, Brazil; Universidade de Uberaba, Brazil
Abstract
Abstract Objective: To evaluate the capacity of fetal Doppler, maternal, and obstetric characteristics for the prediction of cesarean section due to intrapartum fetal compromise (IFC), a 5-min Apgar score < 7, and an adverse perinatal outcome (APO), in a high-risk population. Materials and Methods: This was a prospective cohort study involving 613 singleton pregnant women, admitted for labor induction or at the beginning of spontaneous labor, who underwent Doppler ultrasound within the last 72 h before delivery. The outcome measures were cesarean section due to IFC, a 5-min Apgar score < 7, and any APO. Results: We found that maternal characteristics were neither associated with nor predictors of an APO. Abnormal umbilical artery (UA) resistance index (RI) and the need for intrauterine resuscitation were found to be significant risk factors for cesarean section due to IFC (p = 0.03 and p < 0.0001, respectively). A UA RI > the 95th percentile and a cerebroplacental ratio (CPR) < 0.98 were also found to be predictors of cesarean section due to IFC. Gestational age and a UA RI > 0.84 were found to be predictors of a 5-min Apgar score < 7 for newborns at < 29 and ≥ 29 weeks, respectively. The UA RI and CPR presented moderate accuracy in predicting an APO, with areas under the ROC curve of 0.76 and 0.72, respectively. Conclusion: A high UA RI appears to be a significant predictor of an APO. The CPR seems to be predictive of cesarean section due to IFC and of an APO in late preterm and term newborns.
Subject
Radiology, Nuclear Medicine and imaging
Reference51 articles.
1. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology,2003
2. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy;Graham EM;Am J Obstet Gynecol,2008
3. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses;DeVore GR;Am J Obstet Gynecol,2015
4. Antenatal cardiotocography for fetal assessment;Grivell RM;Cochrane Database Syst Rev,2015
5. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour;Alfirevic Z;Cochrane Database Syst Rev,2017