Assessment Of Fetal Well-being Research Articles

Comparative Assessment of the Umbilical Artery Doppler Velocimetry and Non-Stress Test in Evaluating the Fetal Well-Being among Women with Pre-Eclampsia

Background: Pre-eclampsia is defined as a systemic syndrome characterized by the new onset of raised blood pressure >140/90 mm Hg and proteinuria after 20 weeks of gestation in a previously normotensive woman. Reduction of neonatal complications of pre-eclampsia is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies. Methods: It was a prospective comparative tertiary care hospital based study of pre-eclamptic women admitted in department of Obstetrics and Gynaecology, Lalla Ded hospital over a period of 18 months from March 2020 to September 2021. Written informed consent was obtained from the subjects prior to recruitment to the study. A total of 232 patients who were known case of pre-eclampsia or those who develop pre-eclampsia during hospital stay were included in our study. Results: Both NST and fetal UA Doppler velocimetry were significantly correlated with the perinatal outcome. However; UA Doppler velocimetry had more sensitivity than NST. In contrast, NST had slightly more specificity than UA Doppler velocimetry. Conclusion: The fetal umbilical artery Doppler velocimetry improves the sensitivity for the prediction of poor perinatal outcome when it is combined with the non-stress test. Both the tests are complimentary to one another in fetal surveillance of high risk pregnancies like pre-eclampsia. Keywords: Pre-eclampsia, Umbilical arteries, Ultrasonography, Doppler, NST, Prenatal diagnosis

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women.

To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120-239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Effect of Educational Program on Maternity Nurses’ Knowledge and Practices Regarding Non-invasive Fetal Wellbeing Assessment Methods

Effect of Educational Program on Maternity Nurses’ Knowledge and Practices Regarding Non-invasive Fetal Wellbeing Assessment Methods

High risk pregnancies and implications of color Doppler

The aim of this study is High risk pregnancies &amp; implications of color Doppler. Total 100 were selected with purposive sampling technique, (50 cases) study group of high risk pregnancy taken into the study &amp; compared with an equal number of women with normal pregnancy without complication. In our study we found, maximum cases in age group of 24-34 i.e. 49% in group A whereas in group B 43% in more than 34 age group. 41% normal in group A whereas 27% in group B. C-section 79% in group a &amp; 21% in group B. Emergency caesarean section was uncommon in subjects with normal Doppler USG than those of with abnormal Doppler USG and also from group B.In high risk women like pre eclampsia, diabetes &amp; IUGR. Color Doppler flow velocimetry done repeatedly can predict address foetal events with a great degree of accuracy. Results obtained in study where clinically &amp; statistically significant. Every tertiary hospital should routinely make use of facility for the assessment of fetal wellbeing in high risk cases &amp; ensure a better perinatal outcome.Color Doppler can be used as most effective for fetal surveillance in high risk pregnancy cases. Most importantly it helps in guiding early intervention and outcome.

Decreased fetal movements—the utility of ultrasound to identify infants at risk and prevent stillbirth is poor

Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements. This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester. This was a retrospective cohort study performed at the Mater Mothers' Hospital in Brisbane between 2017 and 2020. We undertook propensity score matching analysis comparing abnormal ultrasound parameters in women with singleton, nonanomalous pregnancies presenting with decreased fetal movements after 28 weeks' gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebroplacental ratio <10th centile, estimated fetal weight <10th centile for gestation, middle cerebral artery peak systolic velocity >1.5 multiples of the median, or deepest vertical pocket of amniotic fluid <2 or >8 cm. After propensity score matching, the study cohort comprised 1466 cases and 2207 controls. The rate of the primary composite outcome was not significantly different between the 2 cohorts (20.2% vs 21.3%; P=.42). There were 30 new cases of small-for-gestational-age detected in the decreased fetal movements cohort, giving a number needed to scan of 48 in the decreased fetal movements group to detect 1 case of small-for-gestational-age. However, the frequency of the composite outcome was higher (13.0% vs 5.4%) at the final scan before birth in women with multiple decreased fetal movement presentations. Despite this, there was no significant difference in clinical outcomes between the 2 cohorts. Ultrasound abnormalities are not increased in women with decreased fetal movements compared with controls.

Fetal Wellbeing Monitoring: A Review Article.

While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal well-being assessment, thus bridging the gap between biotechnology and antenatal medicine. It is broadly divided into early pregnancy, late pregnancy, and during labour assessment. While the early assessment involves genetic check-ups and malformations, the late pregnancy check-ups aim at delivering a healthy fetus at term by normal vaginal delivery. The early tests can be invasive or non-invasive. Non-invasive include cell-free fetal DNA assessment and fetal cell-based assessment. Invasive tests include amniocentesis and chorionic villous sampling. These are followed by chromosomal microarray and next-generation sequencing. Under this procedure, exome sequencing is done, which is either clinical or whole. Sequencing of the whole genome can also be done. A recent advancement is pre-implantation genetic testing. These are mainly useful in identifying monogenic disorders for which the locus causing disease is identified beyond any doubt. In late pregnancy, the most commonly used test is biophysical. It works on the principle that an increase in the fetal heart rate occurs in conjugation with fetal movements. The next widely employed technology is Doppler, which is used to know fetal heart rates, valve timing intervals, and umbilical artery waveforms. Cardiotocography is also widely used both during pregnancy and during labour. It measures the fetal heart rate while correlating it with uterine contractions. Wireless fetal and maternal heart monitoring and telemonitoring are recent upcoming fields.

The possibilities of intrapartum fetal monitorization in obese pregnant women

Obesity, as an epidemic, is one of the major public health challenges of the 21st century. It affects more and more people annually, and through its numerous negative psychological and physical effects as a risk factor it increases the morbidity and mortality of several diseases. It has a major impact on pregnancy; it is well established that both infertility and abortion is more common among obese women. During pregnancy, obesity increases the risk of intrapartum complications, affects the way of delivery, and has an impact on fetal development. Obesity puts an extra burden on the already overloaded maternal circulation, leading to electrophysiological deviations. Increased maternal fat tissue limits the assessment of fetal well-being during labor, which is external fetal monitoring (cardiotocography, CTG) nowadays. It has the advantage of being non-invasive, although subjectivity in the interpretation of the CTG trace and discrepancies in the analysis decreases the sensitivity and the reliability of the method. The current review aims to summarize what kind of intrapartum methods are currently available to have a better assessment of the fetal well-being, and to achieve better perinatal outcomes in the case of obese mothers.

Intrauterine growth restriction and perinatal outcome among oligohydramnios pregnancies

Background: Successful outcome of obstetric well-being is to assess by obtaining healthy mother and child in modern obstetrics. Assessment of fetal well-being is important in timely diagnosis of fetal compromise and management. Amniotic fluid serves a major role in the development of the fetus. Aims and Objectives: The present study aims to evaluate the oligohydramnios pregnancies admitted in IPD of G &amp; O, Bankura Sammilani Medical College &amp; Hospital in terms of intrauterine growth restriction (IUGR) and perinatal outcomes. Materials and Methods: The study was conducted at Bankura Sammilani Medical College and Hospital, West Bengal, in terms of IUGR and perinatal outcomes from April 2020 to September 2021 among 80 antenatal mothers diagnosed to have oligohydramnios and subsequently admitted in-patients-department. Thorough history taking and clinical examination was done. Template was generated in MS Excel sheet and analysis was done on SPSS software. Results: Among 80 antenatal mothers diagnosed with oligohydramnios, the mean age of patients was 22.0750±4.1484. 21 (26.25%) patients had NICU admission and 56 (70.0%) patients had IUGR. In the study, 1 (1.25%) patient was perinatal death and 79 (98.75%) patients survived. In without IUGR, the mean birth weight (mean±SD) of patients was 2.7483±0.2222. In without IUGR, 1 (4.2%) patient had NICU admission. In with IUGR, 20 (35.7%) patients had NICU admission. Conclusion: Ultrasonography plays a major role in early diagnosis of IUGR. IUGR was associated with cesarean section for fetal distress, and NICU admission among oligohydramnios can be predicted using umbilical artery Doppler velocimetry.

Migrant Somali women's experiences with their first contact with the labor ward prior to admission: A qualitative study.

INTRODUCTIONThe first contact with the labor ward is a crucial moment in any birth and can be especially challenging when the woman has a migrant background. The aim of the study was to explore migrant Somali women’s experiences with their first contact with the labor ward prior to admission, in Norway.METHODSIn this qualitative study, data were collected through semi-structured individual interviews and Systematic Text Condensation was the method used to analyze the data. Ten Somali-born women who had given birth in Norway were included.RESULTSThe migrant Somali women’s first contact with the labor ward prior to admission was challenging, due to one-way communication, poor health literacy, and a fear of interventions or adverse outcomes. To improve care, the migrant Somali women highlighted a need for: 1) flexibility, tailored information and practical guidance before birth; and 2) face-to-face assessment in early labor.CONCLUSIONSThe findings in this study indicate that the needs of laboring migrant Somali women are not fully met by antenatal or pre-hospital maternity care services. To improve the critical first contact with the labor ward for migrant Somali women, this study suggests that antenatal care services offer practical guidance on whom to contact and what to expect at the hospital in early labor. Face-to-face assessment of maternal and fetal well-being should be the first choice of care for Somali women in early labor who are unfamiliar with the healthcare system after immigration. Interpretation services need strengthening and our findings support a need for increased continuity of care.

Protein/creatinine ratio versus 24-hours urine protein in preeclampsia.

Proteinuria is one of the diagnostic criteria of preeclampsia (PE). Measurement of 24-hour urine protein is the gold standard method for detection of proteinuria in PE. The 24-hour urine sampling is time-consuming, and inconvenient. To evaluate the accuracy of protein/creatinine (P/C) ratio in detection of significant proteinuria (> 1 g/24-hours urine) in PE. One hundred and ten (110) preeclamptic women were included in this study and admitted for blood pressure monitoring, 24-hour urine collection, fetal well-being assessment and spot urine sample for measuring of P/C ratio. After thorough history and clinical examination, routine antenatal investigations were done for the women included in the study according to the hospital`s protocol, and to exclude pre-existing chronic renal disease. Twenty-four-hour urine collection started on the morning following hospital admission. Spot urine samples were obtained shortly before the 24-hour urine collection for measuring of P/C ratio. Collected data statistically analyzed to evaluate the accuracy of P/C ratio in detection of significant proteinuria in PE. The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% positive predictive value (PPV), 90.2% negative predictive value (NPV), and 94.5% overall accuracy in detection of significant proteinuria (> 1 g/24-hour urine) in PE. The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% PPV, 90.2% NPV, and 94.5% overall accuracy in detection of significant proteinuria (> 1 g/24-hour urine) in PE. This study suggests the use of P/C ratio as an alternative to 24-hour urine protein to detect significant proteinuria in PE.

Manual fetal stimulation during intrapartum fetal surveillance: a randomized controlled trial

BACKGROUNDManual fetal stimulation, either by mechanical manipulation or by stimulation of the fetal scalp, is known to evoke a fetal heart response in a normal fetus. OBJECTIVEThis study aimed to assess the clinical effectiveness of manual fetal stimulation in the assessment of fetal well-being during labor vs no stimulation among women with a singleton pregnancy and to investigate the maternal and neonatal outcomes in the 2 groups. STUDY DESIGNThis was a randomized controlled trial conducted in the department of obstetrics and gynecology at a tertiary care teaching hospital between 2014 and 2016. The inclusion criteria included women with a singleton pregnancy at ≥37 weeks of gestation with cephalic presentation in labor having one of the following abnormalities on fetal heart tracing: fetal heart rate of <110 bpm or >160 bpm, variable decelerations, late decelerations, and minimal or absent beat-to-beat variability. The exclusion criteria included women requiring immediate cesarean delivery, conditions that would preclude a vaginal delivery, and intrauterine fetal demise or a major fetal congenital abnormality. The women were followed up in labor and randomized to either the manual stimulation group or the no stimulation group when one of the cardiotocography abnormalities were present. In the manual stimulation group, the fetus was stimulated abdominally by holding the head in the palm of 1 hand when the cervical dilatation was <3 cm or vaginally by pinching the scalp of the fetus when the cervical dilatation was ≥3 cm. After delivery, a cord blood sample was collected and pH estimated. Mother and baby were followed up until discharge, and mode of delivery, cord blood pH at birth, Apgar scores at 1 minute and 5 minutes, neonatal intensive care unit admissions, and duration of stay were the outcomes studied. Data were entered and compiled as frequency and percentage for categorical variables. For continuous variables, data were calculated using mean and standard deviation. The chi-square test was used for assessing the association between the intervention and fetal and maternal outcomes. RESULTSA total of 327 women were included in the trial, of whom 164 were in the manual fetal stimulation group (group 1) and 163 were in the “no stimulation” group (group 2). The cesarean delivery rates were 25.61% in group 1 and 30.67% in group 2 (P=.308). The mean cord blood pH levels at birth were 7.267±0.027 in group 1 and 7.265±0.024 in group 2 (P=.479), and the Apgar scores at 1 minute and 5 minutes (P=.169 and P=.423, respectively, between the 2 groups) were not found to be statistically different among the 2 groups. CONCLUSIONThere was no considerable change in fetomaternal outcomes with manual fetal stimulation in women having nonreassuring cardiotocographic changes in labor.

Assessment of Fetal and Maternal Well-Being During Pregnancy Using Passive Wearable Inertial Sensor

Assessing the health of both the fetus and mother is vital in preventing and identifying possible complications in pregnancy. This paper focuses on a device that can be used effectively by the mother herself with minimal supervision and provide a reasonable estimation of fetal and maternal health while being safe, comfortable, and easy to use. The device proposed uses a belt with a single accelerometer over the mother’s uterus to record the required information. The device is expected to monitor both the mother and the fetus constantly over a long period and provide medical professionals with useful information, which they would otherwise overlook due to the low frequency that health monitoring is carried out at the present. The paper shows that simultaneous measurement of respiratory information of the mother and fetal movement is in fact possible even in the presence of mild interferences, which needs to be accounted for if the device is expected to be worn for extended times.

Non-reassuring fetal status and anesthetic impact on cesarean section-delivered very-low-birthweight infants.

There is limited evidence concerning the impact on neonatal outcomes of different types of anesthesia used for cesarean delivery due to non-reassuring fetal status (NRFS). We aimed to assess the impact of NRFS and general anesthesia (GA) on neonatal outcomes in very-low-birthweight (VLBW) infants delivered by cesarean section. Data were collected relating to VLBW infants admitted to our institution. Infants were grouped into no-NRFS and NRFS groups and further subcategorized into GA and regional anesthesia (RA) subgroups. Neonatal outcomes were evaluated based on the presence of NRFS and the type of anesthesia. A total of 356 infants were included. The GA subgroup in the no-NRFS group had higher requirements for respiratory support. However, GA was not associated with adverse neonatal outcomes based on the multivariable logistic regression analysis except for 5 min Apgar score <5. On the other hand, NRFS was associated with an increased risk of 5 min Apgar score <5 [adjusted odds ratio (aOR) 2.062, 95% confidence interval (CI) 1.064-3.997], use of high-frequency ventilation (aOR: 2.891, 95% CI: 1.477-5.658), and pulmonary hypertension (aOR: 2.890, 95% CI: 1.436-5.819). In our cohort of VLBW infants, NRFS was a significant risk factor for a low 5 min Apgar score, increased respiratory support requirement, and pulmonary hypertension. Accurate assessment of fetal well-being, timely delivery, and presence of a resuscitation team fully aware of perinatal conditions and anesthetic impact is important.

Multiparametric Investigation of Dynamics in Fetal Heart Rate Signals.

In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive understanding of how linear and nonlinear dynamics are involved in the control of the fetal heart rhythm. In this study, we propose a straightforward processing and modeling route for a deeper understanding of the relationships between the characteristics of the FHR signal. A multiparametric modeling and investigation of the factors influencing the FHR accelerations, chosen as major indicator of fetal wellbeing, is carried out by means of linear and nonlinear techniques, blockwise dimension reduction, and artificial neural networks. The obtained results show that linear features are more influential compared to nonlinear ones in the modeling of HRV in healthy fetuses. In addition, the results suggest that the investigation of nonlinear dynamics and the use of predictive tools in the field of FHRV should be undertaken carefully and limited to defined pregnancy periods and FHR mean values to provide interpretable and reliable information to clinicians and researchers.

Multi-Detector Heart Rate Extraction Method for Transabdominal Fetal Pulse Oximetry.

Intrapartum fetal well-being assessment relies on fetal heart rate (FHR) monitoring. Studies have shown that FHR monitoring has a high false-positive rate for detecting fetal hypoxia during labor and delivery. A transabdominal fetal pulse oximeter device that measures fetal oxygen saturation non-invasively through NIR light source and photodetectors could increase the accuracy of hypoxia detection. As light travels through both maternal and fetal tissue, photodetectors on the surface of mother's abdomen capture mixed signals comprising fetal and maternal information. The fetal information should be extracted first to enable fetal oxygen saturation calculation. A multi-detector fetal signal extraction method is presented in this paper where adaptive noise cancellation is applied to four mixed signals captured by four separate photodetectors placed at varying distances from the light source. As a result of adaptive noise cancellation, we obtain four separate FHR by peak detection. Weighting, outlier rejection and averaging are applied to these four fetal heart rates and a mean FHR is reported. The method is evaluated in utero on data collected from hypoxic lamb model. Ground truth for FHR is measured through hemodynamics. The results showed that using multi-detector fetal signal extraction gave up to 18.56% lower root-mean-square FHR error, and up to 57.87% lower maximum absolute FHR error compared to single-detector fetal signal extraction.

Premature rupture of membranes

Prenatal (premature) rupture of membranes (PROM) is defined as rupture of fetal membranes before the onset of labor or regular uterine contractions. PROM can lead to serious complications such as uterine cavity infection, umbilical cord compression, oligohydramnios, fetal malpresentation, umbilical cord prolapse, preterm delivery, fetal asphyxia and death. Initial evaluation of all term pregnancies with suspected PROM should include confirmation of membrane rupture and assessment of maternal and fetal well-being. Immediate initiation of labor is recommended in term pregnant women with PROM. Compared with expectant management, induction of labor is associated with a reduction in maternal and possibly neonatal infection and lower treatment costs without an increase in cesarean delivery. Induction with oxytocin is recommended. Oxytocin is as effective as prostaglandins, easier to titrate and may be less expensive depending on the preparation. Balloon catheter use is not recommended for cervical ripening in PROM.

Trauma and pregnancy

Key Content Trauma accounts for 10% of annual worldwide deaths, and 6–8% of all pregnancies will experience some form of trauma. Pregnancy is an independent predictor for mortality. Trauma services in the UK were reorganised in 2012. Since then, the odds of survival from major trauma have increased by 19% compared with 2008. Trauma has maternal complications (for example, haemorrhage, abruption and disseminated intravascular coagulation) and fetal complications (such as preterm birth, hypoxic brain injury and death). Clinicians should initiate aggressive fluid resuscitation and strongly consider the possibility of concealed blood loss. Emphasis should be placed on warmed blood products and tranexamic acid. Trauma imaging should not be delayed for fear of risk to the fetus; we must continue to reinforce the tenet that the mother’s health takes priority over the fetus in all decision making and the mother’s condition should be stable prior to the assessment of fetal wellbeing. Learning Objectives To explore the structure of trauma services in the UK. To understand the principles of trauma management and important considerations in the pregnant patient. To appreciate the maternal and fetal outcomes associated with trauma.

Conservative Management After a Single Fetal Death in a Dichorionic Diamniotic Twin Pregnancy and Fetus Papyraceus: A Case Report

Multifetal pregnancies are estimated to represent 3.2% of all pregnancies (80% are dichorionic and 20% monochorionic) and are associated with a higher risk of perinatal morbidity and mortality relative to single pregnancies. The authors report a successful case of conservative management of a dichorionic diamniotic twin pregnancy after a single fetal death in the second trimester of pregnancy. The diagnosis was made in the 22nd week of pregnancy and the pregnancy was followed up until delivery in the 39th week. A healthy (2.855 kg) female infant was born and a dead fetus, approximately 20 cm in length and connected by the rudimentary umbilical cord to the small calcified placenta, was seen. The occurrence of a single fetal death is a relatively common event, which has implications for maternal and fetal outcomes. This diagnosis is relevant due to its potential effect on the survival of the other fetus and on possible maternal complications. In order to avoid complications and achieve the optimal maternal and neonatal outcomes, conservative prenatal follow-up should focus on careful monitoring and serial assessment of both fetal and maternal wellbeing. In gestational losses where the fetus is retained intrauterine for at least 10 weeks, there is the possibility of finding fetus papyraceus at the time of delivery. This is a rare event that results from incomplete reabsorption of the dead fetus, which is then compressed between the membranes and the uterine wall.

Correlation between Doppler Indices as A Predictor of Neonatal Outcome in Normal and Preeclamptic Pregnant Women in The Third Trimester

Background: Doppler flow velocimetry of the umbilical artery and cerebral circulation is a non-invasive modality used for assessment of fetal wellbeing. Doppler studies are more specific and are potentially useful tool in prediction of adverse perinatal outcome in high risk patients. Aim of the current study was to evaluate the efficacy of middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), uterine artery pulsatility index (UAT-PI), and a cerebroplacental ratio (CPR) Doppler indices in assessment of fetal wellbeing. For documentation of the neonatal outcome in preeclamptic women with abnormalities of Doppler indices. Objectives: Assessment of fetal wellbeing and prediction of neonatal outcome in normal pregnant women and woman with preeclampsia by using Doppler indices. Patients and Methods: the study isacase control study included 94 pregnant women (47 normal pregnancy and 47 preeclamptic patients) admitted in Obstetrics and Gynecology Department of Menoufia University during the period from August 2018 to November 2019. All included women underwent Doppler study and were followed up till delivery. Results: Doppler velocimetry studies of both placental and fetal circulation can provide important information as regard fetal wellbeing so can be used to improve fetal outcome. Conclusions: It was observed that all three parameters UAT-PI, MCA-PI and UA-PI when taken into consideration together are good parameters in predictions of perinatal outcome.

The addition of fetal scalp blood lactate measurement as an adjunct to cardiotocography to reduce caesarean sections during labour: The Flamingo randomised controlled trial.

Fetal scalp blood sampling for lactate measurement (FBSLM) is sometimes used to assist in identification of the need for expedited birth in the presence of an abnormal cardiotocograph (CTG). However, there is no randomised controlled trial evidence to support this. To determine whether adding FBSLM reduces the risk of birth by emergency caesarean section in labours complicated by an abnormal CTG, compared with CTG without FBS. Labouring women at a tertiary maternity hospital in Melbourne, Australia with a singleton, cephalic presentation, at ≥37weeks gestation with an abnormal CTG pattern were randomised to the intervention (n=61), with intermittent FBSLM in addition to CTG monitoring, or control (CTG without FBS, n=62). The primary outcome was rate of birth by caesarean section. Secondary outcomes included overall operative birth and fetal and neonatal safety endpoints. ACTRN12611000172909. The smaller than anticipated sample was unable to demonstrate an effect from adding FBSLM to CTG monitoring on birth by caesarean section vs monitoring by CTG without FBS (25/61 and 28/62 respectively, P=0.64, risk ratio 0.91, 95% confidence intervals 0.60-1.36). One newborn infant in the CTG group met the criteria for the composite neonatal outcome of death or serious outcome, neonatal encephalopathy, five-minute Apgar score<4, neonatal resuscitation, admission to neonatal intensive care unit for 96h or more. We were unable to provide robust evidence of the effectiveness of FBSLM to improve the specificity of the CTG in the assessment of fetal wellbeing.