Comparison of modified biophysical profile and Doppler ultrasound in prediction of perinatal outcome in high-risk pregnancies

Background: The objective of this present study was to compare MBPP and umbilical artery Doppler flow in high-risk pregnant women in prediction of perinatal outcome.Methods: A cohort study was done on 150 high-risk pregnant women over 16 months. Antenatal women with singleton pregnancy who delivered within 48 hours of performing MBPP and Doppler USG, with presence of ≥1 high-risk factor like pre-eclampsia/gestational HTN, BOH, post-dated pregnancy, FGR, GDM, maternal heart disease, anaemia, hypothyroidism and IHCP were included in the study. MBPP (NST and AFI) and umbilical artery Doppler was performed. Perinatal outcome was measured in terms of stillbirth/IUD, LBW, Apgar <7 at 5 minutes, admission to NICU, neonatal death within 48 hours of delivery, MSL and neonatal seizures within 24-48 hours. Quantitative variables were compared using independent t-test/Mann Whitney test. Qualitative variables were correlated using Chi square test/Fisher exact test. Sensitivity, specificity, NPV, PPV were calculated and p-value <0.05 was considered statistically significant. Data analysis was done using social sciences (SPSS) licensed version 21.0.Results: Majority belonged to the age group 21-25 years and were between 37-40 weeks of gestation. It was found that highest perinatal complications occurred in those with both abnormal MBPP and Doppler followed by those with only abnormal MBPP (p-value<0.0001).Conclusions: MBPP is a better predictor of perinatal outcome compared to umbilical artery Doppler USG in high-risk pregnant women. MBPP should be done in all high-risk pregnancies even if Doppler is normal. Both the tests must be performed in all high-risk pregnancies to improve perinatal outcome.

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.

The role of non-stress test as a method to evaluate the outcome of high-risk pregnancy: a tertiary care center experience

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests.

A study to correlate admission non stress test and immediate post-partum umbilical cord arterial pH with neonatal outcome

Background: Continuous electronic fetal monitoring in labour has become a standard practice in developed countries; this may not be possible in low middle-income countries. So, this study was conducted to correlate admission non stress test (NST) and immediate post-partum umbilical cord arterial (UCA) pH with neonatal outcome.Methods: This prospective observational study was conducted at tertiary care centre in North India. After informed and written consent, 100 pregnant women with singleton live pregnancy of gestational age ≥32 weeks admitted in labour, were subjected to admission NST and immediately after delivery sample for UCA pH was taken. Clinically relevant neonatal outcome was correlated with admission NST and UCA pH. Appropriate statistical tests were used and p-value <0.05 taken as significant.Results: Admission NST was normal, suspicious, pathological in 67%, 27%, 6% subjects, respectively. Study found statistically significant correlation between admission NST and UCA pH with neonatal outcomes (i.e. fetal distress, need of advanced resuscitation, delayed oral feeding). Fetal distress was seen in 9 newborns, in these 8 delivered by CS and 1 required ventous application. Admission NST had high sensitivity (88.89%) and NPV (98.5%) for detection of fetal distress. The optimal cut off for pH and lactate was 7.25 and 2.55 mmol/L, respectively to predict fetal distress.Conclusions: Admission NST can be considered as a screening modality to detect fetus in distress and it showed good correlation with umbilical cord arterial pH for predicting short term neonatal outcome.

Role of Non-stress Test and Vibroacoustic Stimulation Test in Prediction of Perinatal Outcome in High-risk Pregnancies

Objectives: The aim of the study was to evaluate the fetal well being by non-stress-test (NST) and vibroacoustic stimulationtest (VAST) in high-risk pregnancies, to assess the perinatal outcome, to study the ability of the VAST to convert a false-positive(non-reactive) NST to a reactive one.Materials and Methods: Atotal of 100 pregnant women with >32 weeks gestation having certain high-risk factors were subjectedto NST and if NST came out to be non-reactive, vibroacoustic stimulation was given with artificial larynx. Perinatal outcome wasassessed by various parameters (meconium stained liquor, Apgar score at 5 min, neonatal intensive care units admission). Theresults were analyzed by Chi-square test to find the association between NST, VAST results, and perinatal outcome.Results: It was found that VAST reduced the number of false-positive results by 31%. As compared to NST, VAST had lesssensitivity (78.05% vs. 80.48%), and better specificity (95.08% vs. 83.61%), better positive predictive valve (91.43% vs. 82.35%)in predicting perinatal outcome.Conclusion: The addition of vibroacoustic stimulation to the NST reduced significantly the number of non-reactive tests. NSTwhen reactive does represents a satisfactory indicator for fetal well-being but non-reactive test needs further evaluation beforeany active intervention.

Role of Non-stress Test in Antenatal Fetal Assessment in High-risk Pregnancy in Comparison with Normal Pregnancy

Background and Objectives: Non-stress test (NST) is one of the most widely used primary tests for the assessment of fetal well-being. It is a graphical recording of fetal heart activity and uterine contractions simultaneously and continuously when uterus is quiescent with fetal movements. It has been incorporated into biophysical profile system. It is simple, inexpensive, non-invasive, easily performed, and interpreted. Hence, it can be used to screen a large population as an outpatient department procedure. This study was done to observe the efficacy and diagnostic value of NST for antenatal surveillance and comparison of test results with mode of delivery and adverse perinatal outcome. Materials and Methods: A total of 100 high-risk (HR) pregnant women (study group – selected based on inclusion and exclusion criteria) and 100 low-risk (LR) pregnant women (control group) were randomly enrolled into study and followed up with NST from 32 weeks of gestation and repeated at appropriate intervals in cases of the HR group. Results: In the LR group, there was an increased incidence of intrapartum fetal death (IPFD), meconium-stained amniotic fluid (MSAF), and decreased liquor quantity in non-reactive (NR) subgroup compared to reactive NST (R-NST) subgroup. However, in the HR group, NR-NST was associated with significantly increased incidence of decreased liquor quantity, low Apgar score at 5 min of birth, and perinatal mortality compared to the R-NST subgroup. Although the statistical incidence of IPFD was not significant in the NR-NST subgroup compared to R-NST, it appeared clinically significant. MSAF incidence was not significant in these two NST result subgroups. Sensitivity, specificity, and negative predictive value of NST in the LR group were 100%, 81.8%, and 100%, respectively; likewise, in the HR group, they are 75%, 78.1%, and 98.7%, respectively, for perinatal mortality. Conclusion: NST is a valuable screening test for detecting fetal compromise in both HR and LR fetuses that may have a poor perinatal outcome. Predictive value of NST for perinatal mortality was higher in the LR group compared to the HR group though statistically was not significant.

Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Study of changes in non-stress test following antenatal corticosteroid therapy in preterm pregnancy

Background: Preterm birth is the largest unsolved problem in obstetrics and the single most significant cause of neonatal morbidity and mortality. Preterm labour constitutes 5-10% of pregnancies and is the leading cause of neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life, long term disability (cerebral palsy, blindness, deafness, chronic lung disease). The objectives of this study were to determine whether antenatal corticosteroid administration affects the non-stress test. To evaluate the effect of antenatal steroid on foetal movements. To assess the incidence of respiratory distress syndrome and neonatal mortality after antenatal corticosteroid administration.Methods: All antenatal cases between 28-32 weeks of gestation judged to be at risk for preterm delivery attending the outpatient department or admitted in a tertiary care hospital, Tamil Nadu during the study period of 3 years.Results: The present study was undertaken to evaluate the NST for a period of 3 days following antenatal corticosteroid administration and to study the immediate changes in the mother and the foetus. We found out that there was a statistically significant change (p <0.01) in non-stress test when compared with the pre-betamethasone assay.Conclusions: Corticosteroids can cause metabolic alterations in mother, short- and long-term effect in the foetus.

Study of Oligohydramnios and its perinatal outcome

Background: Importance of amniotic fluid volume as an indicator of fetal status is being appreciated relatively recently. Around 3% to 8% of pregnant women are presenting with low amniotic fluid at any point of pregnancy. The present study was undertaken to study the outcome of pregnancies with Oligohydramnios [(amniotic fluid index) AFI≤5cm] at or beyond 34 weeks.Methods: This study consists of 50 cases of antenatal patients with oligohydramnios (AFI≤5) at or beyond 34 weeks of gestation compared with age and gestation matched 50 normal liquor (AFI≥5 and ≤25). The outcome measures recorded were labor, gestational age at delivery, amniotic fluid index (AFI), mode of delivery, indication for cesarean section or instrumental delivery, APGAR score and birth weight.Results: In the present study, AFI was significantly decreased in cases (3.74±1.2) compared (12.54±2.5) with controls. Variable deceleration was noted in 14 (28%) and late deceleration in 5 (10%) cases. In control group, 2 (4%) had late deceleration. In cases induced labor is in 14 (28%), spontaneous labor 36 (72%). In cases, term normal vaginal delivery was in 15 (30%), PVD in 6 (12%), LSCS in 28 (56%) and instrumental vaginal delivery in 1 (2%). In controls, full term normal vaginal delivery was in 41 (82%), PVD in 5 (10%), LSCS in 4 (8%). APGAR score <7 at 1 minute was in 19 (38%) and at 5 minutes was in 5 (10%) in cases. Birth weight is reduced in cases. IUGR was reported in 9 (18%) in cases.Conclusions: Pregnancies with Oligohydramnios (AFI≤5) is associated with increased rate of non-reactive NST. Routine induction of labor for Oligohydramnios is not recommended. It is preferable to allow patients to go into spontaneous labor with continuous FHR monitoring. Antepartum diagnosis of Oligohydramnios warrants close fetal surveillance.

Management of cervical heterotopic pregnancy with inevitable miscarriage

The objective is to report a case of successful treatment of heterotopic cervical pregnancy resulting from IVF–ICSI conception. Case report from Amrita Institute of Medical sciences: a tertiary care referral hospital. A 47-year-old Primigravida, diagnosed with heterotopic cervical pregnancy at 6 weeks of gestation, presented with significant first trimester vaginal bleeding. Under IV sedation, Transvaginal ligation of descending cervical branches of the uterine arteries arrested the bleeding. The cervical pregnancy was successfully aborted with minimal bleeding and the intrauterine pregnancy was successfully maintained till 32 weeks, after which she required emergency preterm LSCS in view of Severe preeclampsia superimposed on chronic hypertension a non-reassuring non-stress test (NST). The intervention applied maybe used in treatment of heterotopic cervical pregnancy in a low resource setting to control the bleeding.

Study of effect of Oligohydramnios on maternal and fetal outcome.

Background: Amniotic fluid acts like a cushion and helps in growth of fetus, decrease in amniotic fluid volume may lead to increased risk of intrauterine growth retardation (IUGR), meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Objective: This study was done to see effects of Oligohydramnios on fetal outcome in the form of neonatal morbidity and mortality and maternal morbidity. Material and Methods: Present study was done in 100 patients who have completed 28 weeks of pregnancy and above with oligohydramnios, selected randomly after satisfying inclusion and exclusion criteria. Detailed examination done and oligohydramnios was confirmed by measuring AFI on ultrasonography. Associated complications, type of delivery conducted, and fetal outcome for perinatal morbidity & mortality studied. Results: Common causes for Oligohydramnios were idiopathic (56%) and PIH (24%). Most common reason to perform caesarean was fetal distress. Oligohydramnios was related to higher rate of growth retardation and neonatal intensive care unit admission. Conclusion: Oligohydramnios is frequent occurring condition. This condition requires antepartum and intrapartum care. Due to oligohydramnios intrapartum complications, perinatal morbidity and mortality are increasing. Decision between vaginal delivery and caesarean section should be well balanced. Unnecessary maternal morbidity can be prevented. Timely intervention can reduce perinatal morbidity and mortality.

Impact of comprehensive nursing intervention on the accuracy of non-stress test / 中国实用护理杂志

Objective To explore the impact of comprehensive musing intervention on the accuracy of non-stress test (NST). Methods With sealed envelope method, 400 cases of primiparous pregnant women without high risk factors were randomly divided into the research group and the control group with 200 cases in each group. The research group was given comprehensive care intervention, the control group received routine nursing. The incidence of non reaction of non-stress test, Apgar score no higher than 7 points, amniotic fluid pollution and cesarean section rate were compared between the two groups. Results The incidence of non reaction of NST was 15.08% in the research group, which was lower than 29.40% of the control group. The incidence of Apgar score no higher than 7 points and amniotic fluid pollution were 8.5% and 19.0% respectively in the research group, which showed no significant difference compared with those of the control group. The cesarean section rate in pregnant was 38.5% in the research group, which was significantly lower than 65.5% of the control group. Conclusions Comprehensive care intervention is effectively to improve the accuracy of NST , so that it can reduce cesarean section rate.

The clinical significance of deceleration of rate of fetal heart in non-stress test / 中国医师进修杂志

Objective To analyse the clinical significance of variable deceleration and extended deceleration in non-stress test. Methods Studied the clinical characteristics of variable deceleration and extended deceleration of 200 cases who underwent non-stress test from January 2005 to December 2007, and compared corresponding clinical significance and newborn prognosis. Results Variable deceleration and extended deceleration in non-stress test dued to cord entanglement, polyhydramnios and fetal growth restriction. The occurrence of fetal distress and severe asphyxia in nowbom were less in low-grade variable deceleration (8.3%, 1.0%) than those in high-grade variable deceleration (17.7%, 4.8%)and extended deceleration (23.8%, 7.1%). Condusion Variable deceleration and extended deceleration in non-stress test due to cord entanglement mostly, low-grade variable deceleration is not always clue to fetal distress and high-grade variable deceleration and extended deceleration is often clue to fetal distress.

Computerized analysis of fetal heart rate in normal term pregnant women categorized by birth weight and fetal sex / 대한주산의학회잡지

PURPOSE: The objective of this study is to compare the difference of each fetal heart rate (FHR) variables between each categorized group according to birth weight and fetal sex using computerized analysis system of fetal heart rate. METHODS: Non stress test (NST) of four hundred normal pregnant women were grouped based on birth weight to 4 groups, <2,500 g, 2,500~<3000 g, 3,000~<3,500 g and above 3,500 g. Fifty male and 50 female babies entered to each group. So, 100 normal pregnant women entered for the study in each group. For collection and analysis of data and values of each variables, our own FHR interpretation sofware, HYFM-II (Windows version 1.0) was used. RESULT: From the comparison between each group classified by each criteria, there were no specific significant differences in baseline FHR, FHR variability (amplitude & mean minute range), signal loss rate, number of fetal movements, the number of FHR acceleration & the number of FHR deceleration those were obtained by our computerized FHR analysis system. CONCLUSION: We confirm that there were no specific differences in each FHR varibles according to birth weight and fetal sex at least in term normal pregnancy.

Correlation and measurement between stress of mother and fetus using heart rate variability / 대한산부인과학회지

OBJECTIVE: The maternal stress measurement from the heart rate variability and the fetal stress measurement from the fetal heart rate variability in non-stress test (NST) were conducted and the correlation between two measurements was calculated. METHODS: From June 2004 to August 2004, 30 cases who visited for antenatal care and admitted at our hospital above 27 weeks of pregnancy were analyzed for tests. The test consists of simultaneous 20-minute non-stress test and 5-minute stress test in stable state of supine position. From measurement and analysis of fetal heart rate variability in NST and maternal stress, three factors -- balance of an autonomic nervous system, an activity of a sympathetic nervous system, and an activity of a parasympathetic nervous system -- were calculated and analyzed. RESULTS: A Pearson correlation coefficient of the LF/HF ratio of mother and fetus did not show the high significance for the whole population (whose value was -0.014), but after clustering the population according to the gestational age, LF/HF ratio, norm LF, and norm HF for mothers in 38 weeks of pregnancy showed highly positive correlation -- the values were 0.760 (p-value 0.011), 0.569, and 0.569, respectively; the cluster of mothers in 38 weeks was the largest one in the population. And value of a mother in four different week also showed positive correlation (0.801). CONCLUSION: A noninvasive method for measurement of fetal stress was suggested and positive correlation between maternal stress and fetal stress was observed. Thus positive feedback may be expected by maternal stress relieving methods, such as aroma therapy and psychosocial support, and the possibility and basis for the evaluation of the effectiveness on maternal and fetal stability by prenatal education was settled.

Relationship of cholyglycine, blood flow of fetal umbilical artery, and non-stress test in patients with intrahepatic cholestasis of pregnancy / 第三军医大学学报

Objective To explore the predicting value of serum cholyglycine (CG), determination of the blood flow of fetal umbilical artery (S/D), non-stress test (NST) results in the prognosis of the newborns. Methods Serum CG, S/D, NST results in 110 cases of intrahepatic cholestasis of pregnancy were determined by radioimmunoassay, color Doppler ultrasonic instrument, and fetal electronic wardship instrument, respectively. The delivery modes and postnatal Apgar scores were recorded. Results CG levels increased the incidence of abnormal S/D and NST in a dose-dependent manner (P

Computerized analysis of fetal heart rate after acoustic stimulation / 대한산부인과학회잡지

OBJECTIVES: The objectives of this study is to compare the differences of fetal heart rate (FHR) variables between preterm and term pregnancies after acoustic stimulation using computerized analysis of fetal heart rate. METHODS: Eighty-two normal pre-term and term pregnancies entered to this study after conventional 20-minutes nonstress test(NST) and 10-minutes acoustic stimulation test (AST). Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. RESULT: The mean baseline FHR was increased in term pregnancies from 141+/-7.0bpm to 152.7+/-9.7bpm, and in preterm pregnancies from 144.6+/-6.8bpm to 156.8+/-10.2bpm, respectively. The mean baseline FHR was significantly increased in both term and preterm pregnancies (p<0.01. paired t-test). The variability of FHR was increased in term pregnancies from 18.2+/-6.4bpm to 22.6+/-5.0bpm and in preterm pregnancies from 17.8+/-5.5bpm to 22.7+/-5.9bpm, respectively. The variability of FHR was also significantly increased in both term and preterm pregnancies. (p<0.01. paired t-test) CONCLUSION: The mean baseline FHR and the variability of FHR was significantly increased both preterm and term pregnancies. But the difference of each FHR variables between preterm pregnancies and term pregnancies was not statistically significant in this study.

Antepartum non-stress test in “high risk” pregnancy.

In 1980, the fetal heart rate nonstress test (NST) was used as the primary screening procedure for the evaluation of fetal well being at Department of Obstetrics and Gynecology Siriraj Hospital Medical School. The results of the first 2,234 patients’ test in 5 years time are presented. Reactive NST (96.69%) has a good predictive value for the well being of the fetus. The stillborn rate withib 7 days of a reactive NST was 3.7 per 1,000, with the still-births occurring in postdate pregnancies. Nonreactive NST (3.31%) group demonstrated a significant increase in the overall cesarean section rate, the rate of cesarean sections for fetal distress and the perinatal mortality rate. Basd on our experience similar to others’ reports, the NST continues to be a valuable procedure for the asseaament of fetal well being in high risk pregnancies.