ResearchObstetricsThe association between fetal Doppler and admission to neonatal unit at term
Section snippets
Materials and Methods
This was a retrospective cohort study in a single tertiary referral center over an 11 year period from 2002 to 2012. Cases were identified by searching the ViewPoint database (ViewPoint 5.6.8.428; ViewPoint Bildverarbeitung GmbH, Weßling, Germany) in the Fetal Medicine Unit, St George’s Hospital. The inclusion criteria were singleton morphologically normal fetuses born at term that had previously had an ultrasound scan at 34+0–35+6 weeks’ gestation for a variety of indications such as suspected
Results
We identified 2518 pregnancies with fetal Doppler assessment at 34+0–35+6 weeks, in which the delivery occurred at or beyond 37 weeks’ gestation. We excluded 33 pregnancies (1.3%) because they had aneuploidy, major structural abnormalities, stillbirth, or missing outcome data, leaving 2485 pregnancies included in the analysis. The maternal characteristics, ultrasound, and birth indices in the groups requiring and not requiring admission to the neonatal unit are shown in Table 1. The prevalence
Comment
The findings of this study suggest that neonates that were admitted to the neonatal unit at term had significantly lower CPR at 34-36 weeks, whereas both ultrasound EFW and BW percentiles were not significantly different from those not admitted. A multivariate logistic regression demonstrated that CPR MoM at 34-36 weeks was almost twice as likely as GA at delivery to determine the need for neonatal unit admission. It was also the case that, among the SGA neonates at term, those with a lower CPR
References (27)
- et al.
Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study
Am J Obstet Gynecol
(2013) - et al.
Estimation of fetal weight with the use of head, body, and femur measurements, a prospective study
Am J Obstet Gynecol
(1985) - et al.
Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy
Am J Obstet Gynecol
(2005) - et al.
New birthweight and head circumference percentiles for gestational ages 24 to 42 weeks
Early Hum Dev
(1987) - et al.
The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction
Am J Obstet Gynecol
(1999) - et al.
Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study
Am J Obstet Gynecol
(2013) Intrauterine growth restriction. ACOG practice bulletin no. 12
Int J Gynecol Obstet
(2001)The investigation and management of the small-for-gestational-age fetus. Green-top guideline number 31
(2013)Fetal growth compromise: definitions, standards, and classification
Clin Obstet Gynecol
(2006)- et al.
Changes in fetal Doppler as a marker of failure to reach growth potential at term
Ultrasound Obstet Gynecol
(2014)
Detection of fetal growth restriction at autopsy in non-anomalous stillborn infants
Ultrasound Obstet Gynecol
Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol
Fetal Diagn Ther
A critical evaluation of sonar “crown-rump length” measurements
BJOG
Cited by (109)
Cerebroplacental ratio and neonatal outcome in low-risk pregnancies with reduced fetal movement: A prospective study
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology: XPrelabor and intrapartum Doppler ultrasound to predict fetal compromise
2021, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :More recent evidence suggests that an abnormally reduced CPR may represent an early index of hitherto undiagnosed placental insufficiency in nonsmall fetuses; in addition, it may be a risk factor for hypoxic complications in this cohort of fetuses considered to be at a low risk of intrapartum complications.77–79 Over the last decade, several groups have demonstrated that AGA fetuses with a low CPR beyond 36 weeks of gestation are at an increased risk of perinatal complications, suggesting that a low CPR represents subclinical, and thus, undetected placental dysfunction, which limits fetal growth potential.77,79–86 In unselected cohorts of women undergoing ultrasound assessment beyond 37 weeks, Morales-Rosellò et al80 and Khalil et al81 reported a higher incidence of obstetrical intervention because of intrapartum fetal distress, neonatal intensive care unit admission, stillbirth, and perinatal mortality at term in AGA fetuses with low CPR.84
Management of fetuses with apparent normal growth and abnormal cerebroplacental ratio: A risk-based approach near term
2024, Acta Obstetricia et Gynecologica Scandinavica
The authors report no conflict of interest.
Cite this article as: Khalil AA, Morales-Rosello J, Elsaddig M, et al. The association between fetal Doppler and admission to neonatal unit at term. Am J Obstet Gynecol 2015;213:57.e1-7.