Fetal biophysical profile and cerebro-umbilical ratio in assessment of perinatal outcome in growth-restricted fetuses.
OBJECTIVE
To examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of perinatal outcome in growth-restricted and hypoxic fetuses.


METHODS
The prospective clinical study included 87 pregnant women with singleton pregnancies at 28-42 weeks of gestation with clinically verified intrauterine growth restriction (IUGR). After assessment of FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and FBP were assessed twice a week. At delivery, umbilical arterial pH, the occurrence of meconium-stained amniotic fluid (MAF), Apgar score at 5 min and the incidence of cesarean sections were used as outcome parameters.


RESULTS
The mean FBP value was 5.5 +/- 0.96 in cases with MAF, and 6.88 +/- 0.26 in cases without MAF. Also, there was no statistical significance in the relation between the C/U ratio and the appearance of MAF. At pH >7.2, the mean FBP value was 7.11 +/- 0.23, while it was 2.83 +/- 0.79 in newborns with acidosis. Both FBP and C/U values were statistically correlated with pH (p < 0.01). The mean umbilical arterial pH was 7.31 +/- 0.0 at a C/U ratio of >/=1 and 7.21 +/- 0.03 at a C/U ratio of <1. In cases with Apgar scores of 8-10, the mean FBP value was 7.28 +/- 0.23, at Apgar scores of 5-7 it was 3.9 +/- 0.52, while at Apgar scores of 0-4 the mean FBP value was 1.5 +/- 0.5. The mean Apgar score at 5 min was 9.54 +/- 0.09 at a C/U ratio of >/=1, and 8.12 +/- 0.49 at a C/U ratio of <1. The mean FBP value in cases of vaginal delivery was 7.55 +/- 0.31. In cesarean section deliveries, the mean FBP value was 5.97 +/- 0.37. Also, there was a high frequency of cesarean sections in growth-restricted fetuses with a C/U ratio of <1 (p < 0.05), i.e. slightly less than FBP.


CONCLUSIONS
FBP and C/U ratio were associated with low arterial pH, low Apgar score and the rate of cesarean sections (p < 0.05), but there was no association between FBP or C/U ratio and the appearance of MAF (p > 0.5). Due to their good predictive value the FBP and C/U ratio could be used in the prenatal monitoring of growth-retarded and hypoxic fetuses. These two methods can be used as important parameters in the decision to end pregnancies with IUGR, when pathological values occur. Thus a reduction in perinatal morbidity, mortality and the incidence of infants with poor neurologic outcome can be expected.
Habek
Dubravko
D
Department of Obstetrics and Gynecology, Clinical Hospital Osijek, Croatia. dubravko.habek@bj.hinet.hr
Hodek
Branko
B
Herman
Radoslav
R
Jugović
Domagoj
D
Cerkez Habek
Jasna
J
Salihagić
Aida
A
D055592:Biophysical Phenomena; D001703:Biophysics; D001783:Blood Flow Velocity; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D015994:Incidence; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*