Obstet Gynecol Sci.  2018 Mar;61(2):202-208. 10.5468/ogs.2018.61.2.202.

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

Affiliations
  • 1Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. mongkoko@catholic.ac.kr

Abstract


OBJECTIVE
To 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.
METHODS
Fetal 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.
RESULTS
Univariate 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.
CONCLUSION
Abnormal 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.

Keyword

Infant, small for gestational age; Cerebroplacental ratio; Cesarean section

MeSH Terms

Apgar Score
Brain
Cardiopulmonary Resuscitation
Cesarean Section
Cohort Studies
Female
Fetal Monitoring
Fetus*
Gestational Age
Hospitalization
Humans
Infant, Newborn
Infant, Small for Gestational Age
Logistic Models
Odds Ratio
Pregnancy
Respiration, Artificial
Umbilical Arteries

Figure

  • Fig. 1 Overall cesarean section rates and cesarean section rates due to non-reassuring fetal status, in multiparous and nulliparous women. Of 184 small-for-gestational-age fetuses, 130 were nulliparous and 54 were multiparous pregnancies. Of the 130 nulliparous women, 42 (32.3%) had cesarean section. Twenty (47.6%) of them received cesarean section due to non-reassuring fetal status. Among the multiparous women (n=54), 19 (35.2%) had cesarean section and 6 (31.6%) of them received cesarean section due to non-reassuring fetal status.


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