| 1. |
- Breborowicz, Andrzej, et al.
(författare)
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Fetal pulmonary and cerebral artery Doppler velocimetry in normal and high risk pregnancy
- 2014
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Ingår i: Ginekologia Polska. - 0017-0011. ; 85:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. Study design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA / right pulmonary artery pulsatility index (PO ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy.
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| 2. |
- Breborowicz, Andrzej, et al.
(författare)
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Fetal pulmonary and cerebral artery Doppler velocumetry in normal and high risk pregnancy.
- 2014
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Ingår i: Ginekologia Polska. - 0017-0011. ; 85:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization.
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| 3. |
- Brodszki, Jana, et al.
(författare)
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Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 19:3, s. 229-234
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition.
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| 4. |
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| 5. |
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| 6. |
- Cheema, Riffat, et al.
(författare)
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Multivascular Doppler surveillance in high risk pregnancies
- 2012
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 25:7, s. 970-974
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Analysis of fetal arterial and venous Doppler predictability for adverse perinatal outcome. Methods: Blood flow in the uterine, umbilical and middle cerbral arteries, umbilical vein, ductus venosus and Galen vein were examined with in 72 h of delivery in 88 high-risk pregnancies. The managing clinicians were only informed about the results of the umbilical artery Doppler. The Doppler results were correlated to adverse perinatal outcome. Results: Doppler abnormalities were seen in both preterm and term pregnancies. Umbilical venous pulsations (n = 13) were strongly correlated to Apgar score <7 at 5 min, abnormal blood gases, need for ventilation assistance and operative delivery for fetal distress. Twenty-four fetuses had brain sparing in the middle cerebral artery, and forty-five had abnormal umbilical artery Doppler. These were correlated to admission in the neonatal intensive care unit, operative delivery and prematurity. Brain sparing in middle cerebral artery was also correlated to ventilation disturbances in the newborns. Abnormal ductus venosus blood velocity was only seen in 9 cases and not related to adverse outcome. Galen vein pulsations (n = 26) seem to appear earlier than pulsations in the umbilical vein and were not related to adverse outcome. conclusion: Umbilical vein pulsations were better correlated to adverse perinatal outcome than were other Doppler findings including ductus venosus.
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| 7. |
- Cheema, Riffat, et al.
(författare)
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Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.
- 2009
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 85, s. 467-470
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing. AIM: Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth. STUDY DESIGN: A prospective study. SUBJECTS: Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies). METHODS: MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth. MAIN OUTCOME MEASURES: Cord blood gases were related to signs of centralization of fetal circulation in the MCA. RESULTS: No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing. CONCLUSION: Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.
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| 8. |
- Dahlbäck, Charlotte, et al.
(författare)
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Abnormal ductus venosus pulsatility index in the absence of concurrent umbilical venous pulsations does not indicate worsening fetal condition.
- 2013
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 42:3, s. 322-328
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Recordings of blood flow velocity waveform in the ductus venosus (DV) and the umbilical vein (UV) are routinely used in order to predict the fetal condition in high-risk pregnancies. This study investigates the relationship between pathological blood flow in the two vessels and perinatal outcome. METHODS: High-risk pregnancies (n=11865) admitted during 1993-2011 for blood flow examinations, including recordings of DV pulsatility index for veins (PIV) and UV pulsations, were included. The results were related to perinatal outcome, using the last Doppler examination prior to delivery in analysis. RESULTS: Abnormal DV PIV was observed in 3,96%, intra-abdominal UV-pulsations in 1,3% and pulsations in the cord in 0,7% of the cases. As expected, the rate of UV-pulsations increased with increasing DV PIV z-score. Fetuses with a pathological DV PIV, but without UV pulsations showed no signs of compromise. This was also true for cases with a DV PIV >4 SD above the mean (53.7 % had a steady flow in the UV). In contrast, the occurrence of UV-pulsations seems to be an indicator of fetal compromise regardless of level of DV PIV. CONCLUSIONS: Abnormal fetal venous blood velocity is related to adverse outcome of high-risk pregnancies. However, abnormal DV PIV is not an indicator of fetal compromise unless UV-pulsations are concurrently present and should be regarded as an artifact and not an indication for emergency delivery.
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| 9. |
- Dahlbäck, Charlotte, et al.
(författare)
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Alterations in ductus venosus velocity indices in relation to umbilical venous pulsations and perinatal outcome.
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
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Tidskriftsartikel (refereegranskat)abstract
- Abnormal blood velocity in the ductus venosus is more frequently detected than pulsations in the umbilical vein, but both are considered indicators of fetal compromise. The aim of this study was to investigate blood flow patterns in the ductus venosus and the association between individual blood velocity ratios and pulsations in the umbilical vein and perinatal outcome.
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| 10. |
- Dahlbäck, Charlotte, et al.
(författare)
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Increased pulsatility in the fetal ductus venosus is not related to altered cardiac strain in high-risk pregnancies.
- 2016
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 29:8, s. 1328-1333
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Tidskriftsartikel (refereegranskat)abstract
- Blood flow velocity patterns in fetal veins are considered to reflect cardiac function, but have not been convincingly documented. The aim of this study was to generate reference values for fetal cardiac strain and compare it with results in fetuses with signs of increased venous pulsatility.
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| 11. |
- Dahlbäck, Charlotte, et al.
(författare)
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Investigations on atrial function in fetuses with signs of impaired placental function.
- 2015
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Ingår i: Prenatal Diagnosis. - : Wiley. - 1097-0223 .- 0197-3851. ; 35:6, s. 605-611
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac dysfunction has been shown in cases of placental insufficiency, but few reports exist on fetal atrial function. The aim of this study was to generate reference values for atrial strain and compare them to results in fetuses with signs of increased placental resistance and abnormal venous circulation.
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| 12. |
- Dubiel, Mariusz, et al.
(författare)
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Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy
- 2001
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 99:1, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.
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| 13. |
- Dubiel, M, et al.
(författare)
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Computer analysis of three-dimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy
- 2005
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 31:3, s. 321-327
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Tidskriftsartikel (refereegranskat)abstract
- Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.
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| 14. |
- Dubiel, M, et al.
(författare)
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Evaluation of fetal circulation redistribution in pregnancies with absent or reversed diastolic flow in the umbilical artery
- 2003
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Ingår i: Early Human Development. - 1872-6232. ; 71:2, s. 149-156
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To record blood flow velocimetry in the superior mesenteric, hepatic and middle cerebral arteries for detection of circulation redistribution and prediction of perinatal outcome in fetuses with absent or reversed diastolic flow in the umbilical artery. Study design: The fetal superior mesenteric, hepatic and middle cerebral artery blood velocimetry was recorded in 33 pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation between 27 and 41 weeks of gestation. Uterine artery and umbilical vein velocimetries were also recorded. Results: An abnormal mesenteric artery pulsatility, index (PI) was found in four cases; two newborns died due to prematurity, growth retardation and necrotizing enterocolitis. An abnormal fetal hepatic artery PI was found in 17 cases. The brain-sparing effect in the middle cerebral artery was found in 16 cases; three newborns died after delivery. Signs of redistribution in mesenteric, hepatic and middle cerebral artery velocimetry were not related to most of the perinatal outcome variables. Umbilical vein velocimetry correlated with low arterial and venous pH. All perinatal mortalities had umbilical venous pulsations. Conclusions: Signs of visceral circulation redistribution could not predict adverse outcome. Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.
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| 15. |
- Dubiel, M, et al.
(författare)
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Fetal and maternal Doppler velocimetry and cytokines in high-risk pregnancy
- 2005
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 33:1, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Fetal hypoxia and preterm delivery are reported to be strongly associated with brain damage and neurodevelopmental delay. Doppler signs of fetal brain sparing have been described during chronic hypoxia, but whether they are related to brain damage is unknown. The aim of this study was to evaluate if markers of tissue injury, i.e., tumor necrosis factor-alpha. (TNF-alpha) and interleukin-6 (IL-6) are related to signs of increased perinatal vascular impedance and/or fetal brain sparing in high-risk pregnancies. Study design: TNF-alpha and IL-6 levels were evaluated in maternal blood serum of 67 high-risk pregnancies. Serum samples were taken at the time of umbilical, middle cerebral artery and uterine artery Doppler velocimetry examination. The values for TNF-alpha and IL-6 were correlated with reference median values obtained with gestational age in the form of a Z-score. Results: TNF-alpha levels showed values within the normal range in only four cases. IL-6 values were found normal in 14 cases. The Z-score for mean middle cerebral artery pulsatility index (PI) showed a significant correlation to TNF-alpha and IL-6 levels, P < 0.0001 and P < 0.003, respectively. This might suggest a strong correlation between signs of fetal brain sparing and increased maternal serum TNF-alpha and IL-6 levels. Abnormal uterine artery PI and the presence of a "notch" were also highly significantly related to TNF-alpha and IL-6 levels, which were nearly two-fold higher compared to normal uterine artery blood flow and the absence of a "notch". Abnormal cerebro/placental ratios showed significant correlations to TNF-alpha and IL-6 levels. Conclusion: The present results suggest a strong correlation between levels of TNF-a and IL-6 not only for signs of fetal brain sparing, but also for uteroplacental blood flow. This finding supports the role of tissue injury in cases of fetal brain sparing, but whether this is a reflection of brain damage or secondary to placental pathology needs further evaluation.
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| 16. |
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| 17. |
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| 18. |
- Dublel, Mariusz, et al.
(författare)
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Fetal biometry between 20-42 weeks of gestation for Polish population
- 2008
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Ingår i: Ginekologia Polska. - 0017-0011. ; 79:11, s. 746-753
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ultrasound estimating of fetal weight is one of the most frequent examinations during pregnancy. Hitherto, foreign fetometry curves have mostly been used in Poland as there are no national available reference charts that are based on ultrasound fetal biometry. The aim of the present study was to construct new charts based on ultrasound fetometry reference for Polish population. Study design: A group of 959 healthy volunteers with uncomplicated singleton pregnancy joined in a cross-sectional study. The study was designed prospectively to evaluate normal reference charts for fetal ultrasound measurements and estimated fetal weight. Four biometric parameters were studied: biparietal diameter (BPD), head circumference (HQ abdominal circumference (AC) and femur length (FL). Estimated fetal weight (EFW) was calculated using Hadlock et al. formula from 1985. Results: In the course of normal pregnancy an acceleration of growth rate was seen, but with a slight decline at the end of pregnancy, Reference curves for mean, 90th and 95th percentile were constructed for BPD, HC, AC and FL. Estimated fetal weight curves were outlined for both boys and girls. Conclusion: Reference charts for Polish population are similar to foreign curves. Less variation was seen in comparison with national charts based on postnatal weight. Ultrasound method seems to be better than birthweight curves especially in preterm pregnancies. This will improve the diagnosis of a small for gestational age newborn.
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| 19. |
- Epstein, Elisabeth, et al.
(författare)
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An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding.
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 20:4, s. 370-376
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium >/= 5 mm. METHODS: Eighty-three women with postmenopausal bleeding and endometrium >/= 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy. RESULTS: Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness >/= 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89). CONCLUSION: Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.
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| 20. |
- Essén, Birgitta, et al.
(författare)
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Are some perinatal deaths in immigrant groups linked to sub-optimal perinatal care services? Perinatal audit of infants to women from Africa’s Horn delivered in Sweden 1990-96
- 2002
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 109:6, s. 677-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypothesis that sub-optimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, as compared to Swedish mothers. Design: A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women. Setting: Sixty-three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified. Main outcome measures: Sub-optimal factors in perinatal care services, categorised as maternal, medical care, and communication. Results: The rate of sub-optimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the OR was 6.2 (CI 1.9-20); the OR for intrapartal deaths was 13 (CI 1.1-166); and the OR for neonatal deaths was 18 (CI 3.3-100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of IUGR (intrauterine growth restriction), inadequate medication, misinterpretation of CTG (cardiotocography), and interpersonal miscommunication. Conclusions: Sub-optimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio-cultural differences in pregnancy strategies, but also the sub-optimal performance of certain health-care routines in the Swedish perinatal care system.
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| 21. |
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| 22. |
- Essén, Birgitta, et al.
(författare)
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Is there an association between female circumcision and perinatal death?
- 2002
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Ingår i: Bulletin of the World Health Organization. - 0042-9686. ; 80:8, s. 629-632
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHODS: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990–96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.
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| 23. |
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| 24. |
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| 25. |
- Ghosh, Gisela, et al.
(författare)
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Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward.
- 2002
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:9, s. 852-855
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Tidskriftsartikel (refereegranskat)abstract
- Background. Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low-risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress. Methods. Ultrasonically estimated four-quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective 'blind' study comprising 600 low-risk pregnancies. Oligohydramnios was defined as an amniotic fluid index <= 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit. Results. Two-hundred and sixty-seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25-11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied. Conclusion. The results indicate that measurement of the amniotic fluid index in low-risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.
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