Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in small-for-gestational age fetuses at term

• Published in: Archives of gynecology and obstetrics Vol. 300; no. 3; pp. 575 - 581
• Main Authors: Stumpfe, Florian M., Faschingbauer, Florian, Kehl, Sven, Pretscher, Jutta, Stelzl, Patrick, Mayr, Andreas, Schild, Ralf L., Schmid, Matthias, Beckmann, Matthias W., Schneider, Michael O.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2019; Springer Nature B.V
• Subjects: Cardiotocography; Childbirth & labor; Delivery, Obstetric; Endocrinology; Female; Fetal Distress - diagnostic imaging; Fetuses; Gestational Age; Gynecology; Health risk assessment; Human Genetics; Humans; Infant, Newborn; Infant, Small for Gestational Age; Intensive Care Units, Neonatal; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Middle Cerebral Artery - diagnostic imaging; Obstetrics/Perinatology/Midwifery; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Retrospective Studies; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries - diagnostic imaging; Umbilical Arteries - embryology; small-for-gestational age; Cardiotocography; Computerized CTG; Short-term variation; Fetal distress; Cerebroplacental ratio; SGA; Doppler
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-019-05216-7

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.