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OP31.08: Fetal middle cerebral artery Doppler at 40 weeks' gestation in the prediction of emergency delivery for fetal distress in labour

2016; Wiley; Volume: 48; Issue: S1 Linguagem: Inglês

10.1002/uog.16463

1469-0705

F. Crovetto, Giulia Maria Baffero, Nicola Cesano, Fábio Rossi, Stefano Acerboni, S. De Marinis, Luigi Fedele, Barbara Acaia, Nicola Persico,

Preterm Birth and Chorioamnionitis

To evaluate whether fetal middle cerebral artery pulsatility index (MCA PI) and cerebroplacental ratio (CPR) were associated with the rate of emergency delivery for fetal distress during labour in normal fetuses at term of pregnancy. Prospective cohort (October 2014-December 2015) of singleton pregnancies with an estimated fetal weight above the 10th centile at routine third trimester ultrasound underwent a scan for the assessment of fetal MCA PI and umbilical artery PI in the context of the 40 weeks' visit. Three measurements were undertaken for each vessel and the means of the three values were used for statistical analysis. In all cases, Doppler assessment was carried out within 7 days of delivery. The relationship between Doppler measurements and the risk of emergency delivery for non-reassuring fetal status was analysed by logistic regression, and the performance of the model was determined by receiver operating characteristic curve analysis. A total of 403 pregnancies fulfilled the selection criteria. During labour, 75 fetuses (18.6%) showed signs of fetal distress on cardio-tocographic monitoring and were delivered by emergency Caesarean section (n = 57, 76%) or operative vaginal procedure (n = 18, 24%). Compared with the 328 fetuses undergoing a normal vaginal delivery, the 75 fetuses requiring emergency delivery had a significantly lower mean MCA PI (1.30 vs. 1.16, respectively; p < 0.001) and mean CPR (1.78 vs 1.61, respectively; p = 0.001) at the time of the 40 weeks' examination. Multivariate analysis showed that a significant contribution to the need for emergency delivery for fetal distress was only provided by mean MCA PI (p = <0.001). The area under the curve (AUC) was 0.695 [95%CI: 0.621-0.770]) and, for false positive rates of 20% and 30%, the detection rates were 49.3% and 62.7%, respectively. In normal term fetuses, a low MCA PI is associated with an increased risk of emergency delivery for fetal distress during labour.