Alterations in Doppler velocimetry indices of the umbilical artery during fetal hypoxia in labor, in relation to cardiotocography and fetal pulse oximetry findings

Abstract

The aim was to investigate fetal peripheral blood flow using external cardiotocography (CTG), Doppler velocimetry, and pulse oximetry (PO) in normal labor compared with those complicated by hypoxia. During labor, 35 term fetuses with oxygen saturation values (FSPO(2)) between 30 and 40%, and 25 term fetuses with FSPO(2) values < or =30% for a period of 20 s to 2 min were studied. Fetuses were assessed using simultaneous CTG, PO, and Doppler ultrasonography of the umbilical artery (UA). The pulsatility index (PI), resistance index (RI), and flow velocity integral (FVI) were recorded. Peripartum outcomes were compared with those of 30 fetuses with SPO(2) values >40%. All groups presented abnormal CTG patterns and were comparable with regard to maternal age and parity. The Fetal Surveillance Unit of the 2nd Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Athens University, Greece. Umbilical artery Doppler revealed an initial increase in the RI and the PI in the presence of decreased oxygen saturation. The differences observed in Doppler velocity and impedance indices correlated with PO values. Fetal outcomes correlated with UA Doppler findings. Alterations in UA Doppler velocimetry indices were observed during labor-induced fetal hypoxia. PO readings of <40% provoked an increase in the RI and PI. When PO readings remained <30% for >2 min, both the PI and the RI were further increased in a more prominent way. UA velocimetry indices correlated with perinatal outcome.