Evaluation of fetal intrapartum hypoxia by middle cerebral and umbilical artery Doppler velocimetry with simultaneous cardiotocography and pulse oximetry.
OBJECTIVE
To investigate fetal circulation at different stages of hypoxia during labor, and to study blood flow alterations in the brain and peripheral tissues, through simultaneous use of three non-invasive techniques.


METHODS
Ninety two pregnant women between 38 and 41 weeks of gestation, comparable for maternal age and parity, were simultaneously monitored with cardiotocography (CTG), continuous fetal pulse oximetry and Doppler ultrasonography during the first stage of labor. In 70 cases evaluation was successful, and useful data was obtained. Doppler waveforms were obtained before and during abnormal CTG patterns, of both the umbilical (UA) and middle cerebral artery (MCA) to measure the pulsatility index (PI), resistance index (RI), and flow velocity integral (FVI). The study population was divided in three groups, according to CTG and fetal pulse oximetry tracings: 20 term fetuses with normal CTG patterns and oxygen saturation (FSPO(2)) values >40%, 30 term fetuses with abnormal CTG patterns and FSPO(2) values between 30 and 40%, and 20 fetuses with abnormal CTG patterns and FSPO(2) values <30% for a time up to 2 min. These were studied and peripartum outcomes were compared.


RESULTS
Redistribution of blood flow was noted at FSPO(2) values of 37%, in all groups. In the presence of reduced oxygen saturation (near to or below 30%), MCA Doppler showed significantly lower PI (1.06+/-0.33 vs.0.74+/-0.39, p=0.03) and RI (0.59+/-0.14 vs. 0.44+/-0.14, p=0.03), while that of the UA showed mildly higher resistance indices (0.98+/-0.14 vs. 1.28+/-0.50, p=0.01 and 0.57+/-0.12 vs. 0.79+/-0.24, p=0.004, respectively). When an oxygen saturation value of <30% was maintained for greater than 2 min, MCA Doppler indices reversed, likely indicating morbid fetal hypoxia. Differences in fetal outcomes between groups correlated with Doppler and pulse oximetry tracings.


CONCLUSIONS
During active labor the fetus maintains oxygen supply to the brain by redistributing blood flow. In cases of hypoxia this is feasible for only 2 min. We note a strong correlation between fetal pulse oximetry, Doppler velocimetry of the MCA and UA, and fetal morbidity.
Second Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens Medical School, 17 Didimotichou Street, 13676 Thrakomakedones, Athens, Greece. harrysiri@hotmail.com
Charalambos
C
Siristatidis
Emmanuel
E
Salamalekis
Dimitrios
D
Kassanos
Constantinos
C
Loghis
George
G
Creatsas
D000328:Adult; D001783:Blood Flow Velocity; D015148:Cardiotocography; D036861:Delivery, Obstetric; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis*; D018056:Hemorheology; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D010092:Oximetry; D011247:Pregnancy; D018616:Ultrasonography, Doppler, Duplex; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology*