Abstract

Doppler examination of the umbilical artery and the fetal middle cerebral artery is evaluated predominantly in pregnancies with fetuses in cephalic presentation and never has been elucidated in breech presentation. Evidence on the accuracy of fetal weight estimation in dependence of the fetal presentation is controversial. Nevertheless, clinical decisions including recommendations for a cesarean section or labor induction based on these examinations are applied to pregnancies with fetuses in breech presentation. The objective of this study was to investigate the influence of the fetal presentation on fetal weight estimation accuracy, umbilical artery and middle cerebral artery resistance indices (RI) in a prospective case control study. Ultrasound examinations in 305 uncomplicated term pregnancies (153 vertex presentations, 152 breech) were investigated. Non-parametric variables were compared using Pearson’s chi2 test and Wilcoxon chi2 test, depending on variable scaling. Fetal weight estimation accuracy was not significantly different between vertex presentation group (VP) (6.97%) and breech presentation group (BP) (7.96%, p = 0.099). Fetal head circumference measurements were significantly larger in BP (350 mm vs. 341 mm in VB, p > 0.0001) while abdominal circumferences were significantly smaller (VP: 338 mm, BP: 331 mm, p = 0.0039) and weight estimation was not significantly different. Umbilical artery RIs were not significantly different between VP (54.5) and BP (55.3, p = 0.354). Fetal middle cerebral artery RIs also showed no significant differences (VP: 71.2, BP: 70.7, p = 0.335). Our study shows that fetal Doppler (RI) and weight estimation ultrasound originally calibrated in cephalic pregnancies are applicable to pregnancies with fetuses in breech presentation.

Highlights

  • Doppler and biometric ultrasound is a helpful tool during and at the end of each pregnancy

  • Biparietal diameter was significantly larger in breech presentations (BP) as compared to vertex presentations (VP) (BP: 97.7 vs. vertex presentation group (VP): 96.4 mm, p = 0.0438) (Table 2)

  • Head circumference was significantly larger in breech presentations (BP: 349.9 vs. VP: 341.1 mm, p > 0.0001)

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Summary

Introduction

Doppler and biometric ultrasound is a helpful tool during and at the end of each pregnancy. In the national guidelines on breech presentation management, fetal weight estimation is an important issue as well because, e.g., the British guideline requires a fetal weight of 2.5 kg–3.5 kg to recommend a vaginal birth approach [7]. Another requirement is to ensure that no fetal compromise is apparent prior to birth [7]. Studies analyzing Doppler indices use cohorts with both cephalic and breech presenting fetuses Until today these RI and biometric weight estimation cut offs are used in cases with fetuses in breech presentation. Head circumference measurements during biometric weight estimation might be altered by fetal positioning [11,12]

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