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A prospective cohort study on the prediction of fetal distress and neonatal status with arterial and venous Doppler measurements in appropriately grown term fetuses

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the predictive power of the cerebro-placental ratio (CPR) and the venous-arterial index (VAI) for the development of intrapartum fetal distress (FD) and neonatal intensive care unit (NICU) admission.

Methods

Fetal umbilical artery, middle cerebral artery and umbilical vein Doppler measurements were obtained before the active phase of labor in 311 singleton pregnancies at ≥37 weeks. A continuous electronic fetal monitorization was applied, and an umbilical cord blood sample was obtained for each participant. FD and NICU admission were the primary outcomes.

Results

Labor was concluded as uncomplicated spontaneous vaginal delivery (SVD) in 261 (83.9%) cases. The 22 (7.1%) FD cases were subdivided into FD with NICU admission (n: 7; 2.3%) and without NICU admission (n: 15; 4.8%). Six out of 7 (85.8%) FD with NICU admission cases were from nulliparous pregnancies. The combinatory indices (VAI and CPR) reached the highest sensitivity (31.8%) and negative predictive value (94.7%). None of the fetuses, distressed or non-distressed, with CPR ≤ 10th percentile was born with a cord pH < 7.20.

Conclusion

FD frequency was increased in fetuses with a low CPR or low VAI. However, the Doppler patterns were heterogeneous in both subgroups: FD with and without NICU admission. FD seems to be a common endpoint of different circulatory-metabolic disturbances. Parity affects the FD frequency in a manner related but not limited to fetal arterial and venous circulation. Low CPR could be a part of the adaptive mechanisms providing metabolic preparedness for hypoxic episodes.

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Author Contribution

I. Atabay: Project development, Protocol development, Data collection, Manuscript writing. S. Kose: Project development, Protocol development, Data collection, Manuscript writing. E. Cagliyan: Supervision, Data management. B. Baysal: Data collection. E. Yucesoy: Data collection. S. Altunyurt: Project development, Protocol development, Manuscript editing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, 35340, Balcova, Izmir, Turkey

    Ihsan Atabay & Erkan Cagliyan

  2. Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, 35340, Balcova, Izmir, Turkey

    Semir Kose & Sabahattin Altunyurt

  3. Division of Neonatology, Department of Pediatrics, Dokuz Eylul University School of Medicine, 35340, Balcova, Izmir, Turkey

    Bora Baysal & Ebru Yucesoy

Authors
  1. Ihsan Atabay
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  2. Semir Kose
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  3. Erkan Cagliyan
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  4. Bora Baysal
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  5. Ebru Yucesoy
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  6. Sabahattin Altunyurt
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Corresponding author

Correspondence to Semir Kose.

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Conflict of interest

None declared.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the Institutional Ethical Committee of the Dokuz Eylul University (GOA 2014/38-17).

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Informed consent was obtained from all participants.

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Atabay, I., Kose, S., Cagliyan, E. et al. A prospective cohort study on the prediction of fetal distress and neonatal status with arterial and venous Doppler measurements in appropriately grown term fetuses. Arch Gynecol Obstet 296, 721–730 (2017). https://doi.org/10.1007/s00404-017-4462-1

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  • DOI: https://doi.org/10.1007/s00404-017-4462-1

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