Integrated monitoring of fetal growth restriction by computerized cardiotocography and Doppler flow velocimetry.

OBJECTIVE: To investigate the correlations between Doppler flow velocimetry and computerized cardiotocography (cCTG) in fetal growth restriction. STUDY DESIGN: Fifty growth-restricted foetuses with abdominal circumference below the 10th percentile and no major abnormalities were studied. A total of 186 cCTG tracings (at least two per patient) analysed using the HP2CTG system were compared with the corresponding umbilical artery pulsatility index (PI), the PI ratio of umbilical artery to middle cerebral artery, and the ductus venosus systolic/atrial ratio. RESULTS: Worsening in umbilical artery Doppler velocimetry parameters was associated with a significant reduction of short- and long-term variability indices and accelerations. When end-diastolic umbilical artery flow was preserved, a reversed ratio between umbilical artery and middle cerebral artery PIs was not correlated with a worsening of cCTG parameters; in the presence of umbilical artery absent or reversed flow, ductus venosus Doppler velocimetry abnormalities were correlated with a significant reduction of variability. When end-diastolic umbilical artery flow was preserved, there was a progressive increase in variability indices and accelerations with advancing gestational age. In the more compromised fetuses this "maturation" process of cCTG patterns was not found. CONCLUSION: There is a strict correlation between Doppler velocimetry abnormalities and cCTG parameter deterioration, in particular between ductus venosus and variability.

Meconium-stained amniotic fluid and fetal oxygen saturation measured by pulse oximetry during labour.

BACKGROUND AND AIM OF THE WORK: The high false-positive rate of electronic fetal heart rate monitoring is the major obstacle to the correct prediction and diagnosis of intrapartum fetal distress. Fetal pulse oximetry is a safe and accurate indicator of fetal oxygenation. The aim of this study was to evaluate the clinical use of this technique for the diagnosis of fetal hypoxia and for prevention of fetal metabolic acidosis and asphyxia during labour, in the presence of meconium-stained amniotic fluid with or without abnormal fetal heart rate patterns, using a threshold value of 30% oxygen saturation. METHODS: Fetal blood oxygen saturation levels (SpO2) of 58 term fetuses with non-reassuring fetal status were measured during labour by fetal pulse oximetry. In 35 cases the amniotic fluid was stained with meconium at onset of labour. Mean SpO2 levels at the different stages of labour were matched against fetal heart rate patterns, the amniotic fluid status, and neonatal outcome. The 35 cases with meconium-stained amniotic fluid were compared with a control group of 28 pregnant women at term who had meconium-stained amniotic fluid during labour but were not monitored by pulse oximetry. RESULTS: When the fetal heart rate tracings were abnormal, mean SpO2values were significantly lower in the first 30 minutes of application and in the last 30 minutes of labour or before Cesarean section. Meconium-stained amniotic fluid was associated with lower SpO2values only when fetal heart monitoring showed a "non-reassuring" pattern. No cases were observed with severe neonatal acidosis, with Apgar score <7 at 5 minutes, or with other adverse neonatal events. In patients with meconium-stained amniotic fluid, neonatal outcomes were better in the group monitored by pulse oximetry versus the control group, although the differences were not statistically significant. CONCLUSIONS: Continued monitoring of fetal oxygen saturation combined with fetal heart rate monitoring may improve accuracy in the evaluation of fetal well-being. As a result, labour could be more safely managed in pregnancies with non-reassuring fetal status as measured by conventional methods, especially in the presence of meconium-stained amniotic fluid.