Is there any relation between development of persistent non-reassuring fetal heart rate pattern and acutely increased uterine artery vascular flow resistance during dinoprostone use in prolonged pregnancies?
OBJECTIVE
To investigate the relation between changes in Doppler parameters of fetal and uterine arteries and development of persistent non-reassuring fetal heart rate (FHR) pattern during induction of labor with dinoprostone (Propess) in pregnancies at >or=41 weeks gestation.


METHODS
Prospective cohort study.


METHODS
Etlik Zubeyde Hanim Women's Hospital, Turkey.


METHODS
One hundred forty-one prolonged pregnancies.


METHODS
Doppler parameters of umbilical, middle cerebral, and uterine arteries were measured before and 4-6 hours after dinoprostone application between uterine contractions. Non-reassuring FHR pattern and persistent non-reassuring FHR pattern criteria were defined based on NICE 2007 guidelines. Women with successful spontaneous vaginal delivery were recruited as a control group (n=108), while women who underwent cesarean delivery due to persistent non-reassuring FHR pattern were recruited as a study group (n=15).


METHODS
Prediction of non-reassuring FHR pattern with Doppler analysis of uterine and fetal arteries.


RESULTS
After dinoprostone application there was significant enhancement in uterine artery resistance index (RI) in the study group compared to the control group (p=0.002). Receiver operating characteristics curve analysis identified a uterine artery RI increase value of 0.11 as the optimal threshold for prediction of persistent non-reassuring FHR pattern with 73.3% sensitivity and 69.4% specificity. Logistic regression analysis demonstrated that an increase in the uterine artery RI was predictive for persistent non-reassuring FHR pattern (odds ratio (OR) 4.97; 95% CI 1.5-16.8).


CONCLUSIONS
Acute increase in uterine artery RI due to dinoprostone use may end with persistent non-reassuring FHR pattern in prolonged pregnancies. This may allow earlier prediction of persistent non-reassuring FHR pattern development and risk assessment.
Karcaaltincaba
Deniz
D
Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Hospital, Ankara, Turkey. denizaltincaba@yahoo.com
Akdag
Derya
D
Kandemir
Omer
O
Yalvac
Serdar
S
Guven
Emine Seda Guvendag
ES
Haberal
Ali
A
D000282:Administration, Intravaginal; D000328:Adult; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D015232:Dinoprostone / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007751:Labor, Induced; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D010120:Oxytocics / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects*; D055815:Young Adult
D003692:Delayed-Action Preparations; D010120:Oxytocics; D015232:Dinoprostone