Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses

S. Turan, O. M. Turan, C. Berg, D. Moyano, A. Bhide, S. Bower, B. Thilaganathan, U. Gembruch, K. Nicolaides, C. Harman, A. A. Baschat

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To investigate the performance of non-stress test (NST), computerized fetal heart rate analysis (cCTG), biophysical profile scoring (BPS) and arterial and venous Doppler ultrasound investigation in the prediction of acid-base status in fetal growth restriction. Methods: Growth-restricted fetuses, defined by abdominal circumference < 5th percentile and umbilical artery (UA) pulsatility index > 95th percentile, were tested by NST, cCTG, BPS, and UA, middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) Doppler investigation. The short-term variation (STV) of the fetal heart rate was calculated using the Oxford Sonicaid 8002 cCTG system. Relationships between antenatal test results and cord artery pH < 7.20 were investigated, using correlation, parametric and non-parametric tests. Results: Fifty-six of 58 patients (96.6%) received complete assessment of all variables. All were delivered by pre-labor Cesarean section at a median gestational age of 30 + 6 weeks. The UA pulsatility index (PI) was negatively correlated with the cCTG STV (Pearson correlation -0.29, P < 0.05). The DV PI was negatively correlated with the pH (Pearson correlation -0.30, P < 0.02). The cCTG mean minute variation and pH were not significantly correlated (Pearson correlation 0.13, P = 0.34). UV pulsations identified the highest proportion of neonates with a low birth pH (9/17, 53%), the highest number of false positives among patients with an abnormal BPS, abnormal DV Doppler and a STV < 3.5 ms, and also stratified false negatives among patients with an equivocal or normal BPS. Abnormal DV Doppler correctly identified false positives among patients with an abnormal BPS. cCTG reduced the rate of an equivocal BPS from 16% to 7.1% when substituted for the traditional NST. Elevated DV Doppler index and umbilical venous pulsations predicted a low pH with 73 % sensitivity and 90% specificity (P = 0.008). Conclusion: In fetal growth restriction with placental insufficiency, venous Doppler investigation provides the best prediction of acid-base status. The cCTG performs best when combined with venous Doppler or as a substitute for the traditional NST in the BPS.

Original languageEnglish (US)
Pages (from-to)750-756
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume30
Issue number5
DOIs
StatePublished - Oct 2007
Externally publishedYes

Keywords

  • Arterial Doppler
  • Biophysical profile scoring
  • Computerized CTG
  • Cord pH
  • Fetal growth restriction
  • Non-stress test
  • Venous Doppler

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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