engleski

Fetal biophysical profile amd cerebro-umbilical ratio in the assessment of perinatal outcome in growth-restricted fetuses

Aid: to investigate the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of perinatal outcome in growth-restricted and hypoxic fetuses. Study design: The prospective clinical study included 87 pregnant women with singelton pregnancies at 28-42 weeks of gestation with clinically verified intrauterine growth restriction (IUGR). After assessment of FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and FBP were assessed twice a week. At delivery, umbilical arterial pH, the occurence of meconium-stained amniotic fluid (MAF), Apgar score at 5 min and the incidence of cesarean section were used as outcome parameters. Results: The mean FBP value was 5.5 +/- 0.96 in cases with MAF, and 6.88 +/- 0.26 in cases without MAF. Also, there was no statistical significance in the relation between C/U ratio and the appearance of MAF. At pH > 7.2, the mean FBP value was 7.11 +/- 0.23, while it was 2.83 +/- 0.79 in newborns with acidosis. Both FBP and C/U values were statistically correlated with pH (p<0.01). The mean umbilical arterial pH was 7.31 +/- 0.0 at a C/U ratio of >/= 1 and 7.21+/- 0.03 at a C/U ratio of < 1. In cases with Apgar scores of 8-10, the mean FBP value was 7.28 +/- 0.23, at Apgar scores of 5-7 it was 3.9 +/- 0.52, while at Apgar scores of 0-4 the mean FBP value was 1.5 +/- 0.5. The mean Apgar score at 5 min was 9.54 +/- 0.09 at a C/U ratio of greater then or equal to 1 , and 8.12 +/- 0.49 at a C/U ratio of < 1. The mean FBP value in cases of vaginal delivery was 7.55 +/- 0.31. In cesarean section deliveries, the mean FBP value was 5.97 +/- 0.37. Also, there was a high frequency of cesarean sections in growth-restricted fetuses with a C/U ratio of < 1 (p < 0.05), i.e. slightly less then FBP. Conclusions: FBP and C/U ratio were associated with low arterial pH, low Apgar score and the rate of cesarean sections (p<0.05), but there was no association between FBP or C/U ratio and the appearance of MAF (p> 0.5). Due to their good predictive value, the FBP and C/U ratio could be used in the prenatal monitoring of growth-restricted and hypoxic fetuses. These two methods can be used as important parameters in the decision to end pregnancies with IUGR, when pathological values occur. Thus a reduction of perinatal morbidity, mortality and the incidence of infants with poor neurological outcome can be expected.

fetal hypoxia; intrauterine growth restriction; fetal biophysical profile; cerebro-umbilical ratio; perinatal outcome

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