[Prediction of fetal wellbeing with Doppler flowmetric profile in pregnant hypertensive women]. / Predicción del bienestar fetal mediante el perfil flujométrico Doppler en embarazadas con hipertensión.

In order to evaluate the diagnostic accuracy of the Doppler ultrasonography profile in the assessment of fetal wellbeing in hypertensive pregnancies, 171 women at 36-42 week's gestation were included. A Doppler color ultrasound scanning was made and the score of the Doppler ultrasonography profile were correlated with the neonatal outcome, with one minute Apgar's score or admission to neonatal intensive care unit as main outcome. The Doppler ultrasonography profile includes: umbilical artery Doppler flow velocity waveforms, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. In 145 cases (84.7%) had gestational hypertension without proteinuria, 22 patients (12.9%) had chronic hypertension and only in 4 cases (2.4%) preeclampsia was found. In 101 patients (59%) a cesarean section was made, 66 cases delivered normally and 4 (2.4%) patients had complicated vaginal delivery. Scores of diagnostic tests were: sensitivity 44%, specificity 99%, positive predictive value 80% and negative predictive value 97%, with an average accuracy of 71.5%. The multiple logistic regression analysis with 5 parameters of the Doppler ultrasonography profile had a determination coefficient (R2 = 0.15125) P < 0.01, and umbilical artery Doppler flow velocity waveforms had a regression coefficient--31.3959 (P < 0.05). It was concluded that the Doppler ultrasonography profile is a test with high predictive values in assessing fetal wellbeing in hypertensive pregnancies and the umbilical artery Doppler flow velocity alone is a significant variable in the multiple logistic regression analysis.

[Color Doppler flowmetry values in fetuses with nuchal cord encirclement]. / Valores de flujometría Doppler color en fetos con circular de cordón.

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.