The relationship between fetal biophysical assessment, umbilical artery velocimetry, and fetal acidosis.
In a prospective study of 62 patients undergoing cesarean delivery before the onset of labor, fetal biophysical assessment and umbilical artery systolic-diastolic ratios (S/Ds) were performed within 3 hours of delivery. There was a significant relationship between the fetal biophysical profile score and cord arterial as well as cord venous pH. However, there was no identifiable relationship between S/D and cord arterial or venous pH. The efficacies of the biophysical components alone (nonstress test [NST] and fetal biophysical profile) and in combination with S/D to predict fetal acidosis were determined. The NST had the best sensitivity (100%) and negative predictive value (100%). The fetal biophysical profile had the best specificity (91%), positive predictive value (62%), and overall efficiency (90%). The S/D had the lowest sensitivity (66%), specificity (42%), positive predictive value (16%), negative predictive value (88%), and overall efficiency (45%). The addition of S/D to the NST or fetal biophysical profile did not improve diagnostic accuracy. These data suggest that the NST should be used as a primary test for the antepartum detection of fetal acidosis, whereas the fetal biophysical profile is a reasonable adjunct test. The umbilical artery S/D, as determined by continuous-wave Doppler velocimetry, has no value as a primary method or an adjunct in the antepartum detection of fetal acidosis.
Vintzileos
A M
AM
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington.
Campbell
W A
WA
Rodis
J F
JF
McLean
D A
DA
Fleming
A D
AD
Scorza
W E
WE
D000138:Acidosis / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D055592:Biophysical Phenomena; D001703:Biophysics; D003971:Diastole; D005260:Female; D005312:Fetal Blood; D005315:Fetal Diseases / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D013599:Systole; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*