Fetal heart rate baselines in twins. Interobserver agreement in antepartum estimation.

OBJECTIVE: To assess interobserver agreement in antepartum estimation of fetal heart rate (FHR) baselines in twins. STUDY DESIGN: Two residents and one specialist in obstetrics and gynecology, all with special interest in FHR monitoring, independently estimated baselines in 162 consecutive antepartum FHR tracings recorded in 24 twins. Tracings were obtained with a dual-channel fetal monitor for the simultaneous recording of both twins' heart rates. Baselines were estimated, as single values corresponding to the mean of the lowest stable FHR segment, in the absence of fetal movements and uterine contractions, within physiologic limits (110-150 beats per minute [bpm]). If these criteria were not met, the possibility of persistent bradycardia or tachycardia was considered, and if this was confirmed in a tracing with at least 40 minutes, a baseline < 110 or > 150 bpm was chosen. Interobserver agreement was assessed by the proportions of agreement (PA), kappa statistic (K) and intraclass correlation coefficient (ICCC), with 95% confidence intervals (CIs). RESULTS: Interobserver agreement was excellent, with a PA of 0.90 (95% CI: 0.89-0.91), K of 0.88 (95% CI: 0.84-0.92) and ICCC of 0.91 (95% CI: 0.88-0.94). CONCLUSION: Interobserver agreement in antepartum estimation of fetal heart rate baselines in twins was excellent with the baseline concept used in this study.

[Pattern of intrauterine growth and Doppler flowmetry]. / Padrões de crescimento intra-uterino e fluxometria Doppler.

The aim of this study was to evaluate the accuracy of ultrasound biometric and hemodynamic fetal parameters for the prenatal diagnosis of intrauterine retardation in a sample of 438 pregnant women who had their first visit before the 16th week of gestation at the outpatient clinic of the Department of Obstetrics and Gynecology, S. Joào Hospital. The results are presented for 427 mother-infant pairs corresponding to singleton pregnancies uncomplicated by congenital malformations. The prevalence of SGA was 4.9%, 86.2% for AGA and 8.9% for LGA. A relatively low sensitivity and high specificity were calculated for the ultrasound parameters evaluated, as observed in previous studies performed in other populations. Mean values for the differences of umbilical vessels resistance index measured at 28-32 and 35-37 gestation weeks were significantly lower in SGA newborns, probably reflecting a sustained compromise of vascular compliance (umbilical/placental). The observed lack of agreement between the pre and the postnatal diagnosis of SGA emphasises the need to define local reference birthweight curves or the careful adoption of European standards obtained in populations identical to our.