Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term.
10.5468/ogs.2018.61.2.202
- Author:
Ji Hye JO
1
;
Yong Hee CHOI
;
Jeong Ha WIE
;
Hyun Sun KO
;
In Yang PARK
;
Jong Chul SHIN
Author Information
1. Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. mongkoko@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Infant, small for gestational age;
Cerebroplacental ratio;
Cesarean section
- MeSH:
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
- From:Obstetrics & Gynecology Science
2018;61(2):202-208
- CountryRepublic of Korea
- Language:English
-
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.
