Prediction Of Adverse Neonatal Outcome Research Articles

Comparing the cerebro-placental to umbilico-cerebral Doppler ratios for the prediction of adverse neonatal outcomes in pregnancies complicated by fetal growth restriction

Objective The cerebroplacental ratio (CPR) has shown utility as a surrogate marker for fetal growth restriction and can be used to stratify the risk for adverse perinatal outcomes in affected pregnancies. However, recent studies suggest that its inverse, the umbilico-cerebral ratio (UCR), may be a better predictor of such outcomes. The aim of this study was to compare the prognostic accuracy of CPR to that of UCR Doppler in predicting short-term adverse perinatal outcomes in growth-restricted fetuses. Methods We conducted a secondary analysis using data from a prospective study on women referred for fetal growth ultrasounds between 26 and 36 weeks of gestation and with an EFW < 10th percentile by Hadlock standard. The CPR and UCR were converted into Z-scores adjusted for gestational age at ultrasound. Abnormal CPR was defined as Z-score below the 10th percentile for the gestational age and abnormal UCR as Z-score above the 90th percentile. We calculated sensitivity and specificity of the two Doppler parameters for predicting composite adverse perinatal outcome (APO) defined as the presence of any one of the following: umbilical cord arterial pH <7.10, Apgars at 5 min <7, NICU admission,grade III/IV intraventricular hemorrhage (IVH), neonatal seizure and death. Logistic regression analysis was performed, ROC curves plotted and the area under the ROC curve (AUC) were compared between CPR and UCR. Results Over the study period, there were 197 women meeting inclusion criteria, of which 27 (13.7%) had a composite adverse neonatal outcome. The sensitivity using CPR Z-score for predicting the composite APO was higher thanwas similar to using UCR Z-score (39.3% compared with 37%) for a similar specificity (94.7 versus 94.1), respectively. However, the positive predictive value (PPV) was higher for CPR (55% vs UCR 50%) and the negative predictive values (NPV) were similar. For a fixed false positive rate of 10%, the detection rates for adverse neonatal outcomes were 40% using either CPR or UCR. The AUC for CPR and UCR were 0.70 and 0.68, respectively. Conclusion This study did not find any advantage in utilizing the UCR over the CPR.

Prediction of adverse neonatal outcome among newborns born through meconium-stained amniotic fluid.

To study maternal and intrapartum factors associated with adverse neonatal outcome in deliveries complicated by meconium-stained amniotic fluid (MSAF). A retrospective cohort study of all women with singleton gestations undergoing trial of labor with MSAF during 2011-2020. Deliveries with adverse neonatal outcome were compared with deliveries without. Overall, 11329 were included; 376 (3.3%) neonates were diagnosed with adverse neonatal outcomes. Multivariable regression analysis underlined the following factors as independently associated with composite adverse neonatal outcome: pregestational diabetes (odds ratio [OR] 3.21, 95% confidence interval [CI] 1.09-9.43, P=0.031), polyhydramnios (OR 2.14, 95% CI 1.33-3.44, P=0.002), fever (OR 2.52, 95% CI 1.67-3.80, P<0.001), and amnioinfusion (OR 1.73, 95% CI 1.24-2.2438, P=0.003). When 0, 1, 2, and 3 of the independent risk factors identified were present, the rates of adverse neonatal outcome were 2.9%, 5.5%, 10.0%, and 100%, respectively. The current study's results suggest that special attention should be payed to deliveries complicated by MSAF and with any of the following factors-polyhydramnios, intrapartum fever, amnioinfusion, and pregestational diabetes.

Adverse Neonatal Outcome are More Common among Babies Born by Cesarean Section than Naturally Born Babies at Public Hospitals in Eastern Ethiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia.

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

A Comparative Study on Adverse Pregnancy Outcomes in Pregnant Women with Different Age

Introduction: Delayed childbearing is increasing. Increased maternal age has been associated with increased risk of pregnancy complications. On the other hand, the adolescent pregnancy has traditionally been considered high-risk, especially in developing countries. Objective: This study aimed to compare the adverse pregnancy outcomes in different age groups of pregnant women. Materials and Methods: The analytical study with cross-sectional design was conducted on 345 pregnant women referred to one of the maternity hospitals in Rasht, Iran in 2018 who were selected by sequential sampling method. They were followed from gestational age &gt;37 weeks until delivery in 3 groups: &lt;19 years, 19-35 years and &gt;35 years. The data collection tool was a two-part researcher-made questionnaire which surveys demographic, fertility, and socioeconomic information and adverse maternal and neonatal outcomes. The collected data were analyzed using descriptive and inferential statistics (Chi-square test, Fisher’s exact test, Kruskal-Wallis test, ANOVA, Bonfrroni test, Spearman correlation test, and multiple linear regression analysis). Results: The highest prevalence of maternal diabetes mellitus (29.7%) and cesarean section (72.46%) were reported in the age group &gt;35 years. The highest frequency of premature rupture of membranes (18.8%) and abnormal fetal presentation (13.8 %) were reported in age groups &lt;19 years and 19-35 years, respectively. Among maternal outcomes, maternal diabetes, abnormal fetal presentation, premature rupture of membranes and delivery by cesarean section were significantly different between three groups (P&lt;0.05). There was a significant difference between maternal age and neonatal outcomes in ages groups &lt;19 years and 19-35 years (P&lt;0.05). Multiple linear regression model showed that the maternal age &lt;19 years was a predictor of adverse neonatal outcomes. The group &lt;19 years reported more adverse outcomes than the age group 19-35 years (β=0.282, 95% CL: 0.002-0.561, P=0.049). Conclusion: All age groups of pregnant women faced some pregnancy outcomes. Due to Iran’s new plan to encourage childbearing, prenatal screening, and receiving more prenatal care, we recommend pregnant women to participate in childbirth preparation training courses.

Predictors of adverse neonatal outcome in pregnancies complicated by placenta previa

IntroductionWe aimed to underline the determinants of adverse neonatal outcome in gestations complicated by placenta previa (PP). MethodsA retrospective study including all women diagnosed with placenta previa carrying a singleton gestation who delivered between 2011 and June 2019. Gestations with adverse neonatal outcomes were compared to those without. In a secondary analysis, we further studied the rate of Placenta accreta spectrum (PAS) in relation to number of previous cesarean deliveries. ResultsOverall, 548/84,558 (0.6%) singleton deliveries were complicated by PP (0.6%). PAS was noted in 105 (19.2%) cases. After exclusion of PAS cases, adverse neonatal outcome occurred in 149/443 (33.6%), median gestational age of delivery was 37 0/7 with a median birthweight of 2780 g. In a univariate analysis, adverse neonatal outcome was associated with emergent delivery and general anesthesia [56.8% vs. 20.8%, OR 5.00 (95% CI) 3.24–7.72, p < 0.001 and 54.4% vs. 24.8%, OR 3.60 (95% CI) 2.37–5.47, p < 0.001, respectively]. Gestational age at delivery was lower in the adverse outcome group (mean 35 1/7 vs. 37 3/7, p < 0.001). In a multivariate regression analysis, general anesthesia and gestational age at delivery were independently associated with adverse neonatal outcome [adjusted odds ratio (aOR) 2.26 (95% CI) 1.18–4.31, p = 0.01, aOR 1.10 (95% CI) 1.05–1.16, p < 0.001. Analysis of the rate of PAS among women with previous cesarean delivery and PP revealed that no cases of PAS were noted when no prior cesarean delivery was present. The rate of PAS for previous 1, 2, 3, 4 and 5 cesarean deliveries was 26.7%, 43.5%, 65.5%, 55.6% and 66.7% respectively. DiscussionEfforts should be made to avoid general anesthesia in deliveries of PP.

Predictive factors in pregnancies with reduced fetal movements: a pilot study

Background Pregnancies with reduced fetal movements (RFM) are at risk for poor neonatal outcomes and stillbirth. Aim To investigate whether Doppler measurements or angiogenic factors are good predictors of adverse neonatal outcomes in pregnancies with RFM. Methods This is a prospective pilot cohort study of 3243 women seeking care for RFM. Standard care was carried out in all cases. An extra Doppler examination was performed in 128 women to assess the flow in the middle cerebral artery, the umbilical artery, and the uterine artery. In 62/128 pregnancies, a maternal blood sample was obtained for angiogenic and antiangiogenic factors. The composite neonatal outcome of the study was one or more of the following factors: Apgar score <7 at 5′, arterial aPh in the umbilical cord ≤7.1, transfer to Neonatal Intensive Care (NICU), stillbirth, and small for gestational age (SGA). Results In 14.1% (18/128) of the Doppler group and 11.7% (365/3115) of the standard care group, there was an adverse neonatal outcome (p = .51). A higher intervention rate was found in the Doppler group (28% vs. 5.4%, p < .01). The predictive model of adverse neonatal outcomes in women with RFM with angiogenic factors was 0.73 (95% CI 0.54–0.92). The area under the curve improved to 0.89 (CI 95% 0.81–0.97) when parity was added to the model. Conclusion Angiogenic factors may have a place in the prediction of the neonatal outcome of RFM pregnancies. The prediction model’s capacity was driven by parity. The obstetrical intervention rate increased with additional Doppler examinations.

VP43.15: The role of CPR as a predictor of adverse neonatal outcome in MCBA twins

VP43.15: The role of CPR as a predictor of adverse neonatal outcome in MCBA twins

VP36.20: Antenatal predictors of adverse neonatal outcome in pregnancies complicated by gestational diabetes

VP36.20: Antenatal predictors of adverse neonatal outcome in pregnancies complicated by gestational diabetes

Main Fetal Predictors of Adverse Neonatal Outcomes in Pregnancies with Gestational Diabetes Mellitus.

The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. These associations were independent of maternal anthropometric and metabolic predictors, with the exception of cesarean section. FWC was the most significant predictor for NWC, LGA and SGA, while FACC was the most significant predictor for prematurity and FACC > 90% for emergency cesarean section. In women with GDM, third-trimester fetal anthropometric parameters have an important role in predicting adverse neonatal outcomes beyond the impact of maternal predictors.

A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes.

To determine a cut-off value for systemic immune-inflammation index (SII)(neutrophil × platelet /lymphocyte) in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes (PPROM). This retrospective cohort study was conducted among singleton pregnancies with PPROM. Cases were divided into two main groups: Group 1) PPROM diagnosed at 24th-28th weeks of gestation and Group 2) PPROM diagnosed at >28th-34th weeks of gestation. Thereafter, main study groups were divided into two subgroups: Subgroup A: pregnancies with favorable neonatal outcomes and Subgroup B: pregnancies with composite adverse neonatal outcomes. Subgroups were compared in terms of demographic features, clinical characteristics, laboratory test results and SII values. Furthermore, cut-off values of SII for the prediction of composite adverse neonatal outcomes were determined for two main groups. A Mann-Whitney U test was conducted to compare the median values and the chi-square test was used to compare categorical variables among the groups. Receiver operating characteristic (ROC) curves were used to assess the performance of SII value in predicting composite adverse neonatal outcomes. Significant differences were observed for median platelet and SII values between the subgroups (P < 0.001 for both in group 1 and P = 0.002 and P = 0.005, respectively, in group 2). Cut-off values of 1695.14 109 /L (83.3% sensitivity, 85.7% specificity) and 1430.90 × 109 /L (71.4% sensitivity, 75.7% specificity) for composite adverse neonatal outcomes were determined, respectively in group 1 and 2 according to the ROC curve analysis. SII may be used as an additional indicator for the prediction of adverse neonatal outcomes in PPROM.

Fetal Arterial Doppler Ultrasound in Late Weeks of Pregnancy in Relation to Neonatal outcome

Early prediction of adverse neonatal outcome would be possible by Doppler impedance indices of middle cerebral artery (MCA), umbilical artery (UmA), and descending aortal artery (AO) that result in decrease neonatal morbidity and mortality rate. the present study was: at diagnosis of placental dysfunction and fetal hypoxia by evaluation of fetal arterial Doppler velocimetry of Umbilical artery (UmA), Middle cerebral artery (MCA) and fetal descending abdominal Aorta (AO).Evaluation of cerebro-placental ratio (MCA/UmA) and cerebro-aortic ratio (MCA/AO) in late weeks of pregnancy will be studied as predictors for neonatal outcome in complicated and uncomplicated pregnancies. This study conducted at the Department of Obstetrics and Gynecology and the Ultrasound Unit of Benha University Hospital and Benha Teaching Hospital on 100 pregnant women . 25% of included patients admitted to NICU , there was significant relation between NICU admission and MCA RI ,AO RI, AO PI. Ultrasound examination and Doppler monitoring provide a non-invasive repetitive method for supervising fetuses with any abnormalities in order to apply an adequate management.

334: Comparing cerebro-placental (CPR) and umbilico-cerebral (UCR) Doppler ratios for the prediction of adverse neonatal outcomes

The CPR (Middle cerebral artery PI/ Umbilical artery PI) has been shown to improve identification of pregnancies complicated by fetal growth restriction at risk for adverse neonatal outcomes. However, recent studies suggest that the inverted ratio, umbilico-cerebral ratio (UCR), may be a better index to predict these outcomes. We aimed to compare CPR to UCR Doppler in the prediction of short term adverse neonatal outcomes in pregnancies affected by fetal growth restriction. We conducted a secondary analysis using data from a prospective study on women referred for fetal growth ultrasounds between 26 and 36 weeks of gestation and with an EFW < 20th percentile by Hadlock standard. Umbilical artery and middle cerebral artery Doppler assessments were performed. Our primary outcome was a composite of adverse outcomes, including any of the following: umbilical cord arterial pH < 7.10, APGARS at 5 minutes < 7, NICU admission, respiratory distress syndrome (RDS), seizure, grade III or IV IVH or death. The CPR and UCR were converted into Z-scores adjusted for gestational age at ultrasound. We calculated sensitivity and specificity of the two Doppler parameters. Logistic regression analysis was performed, ROC curves plotted and the area under the ROC curve (AUC) were compared between CPR and UCR. Of 197 women meeting inclusion criteria, 27 (13.7%) had a composite adverse neonatal outcome. The median Z-scores for CPR and UCR were - 0.082 and -0.16, respectively. The sensitivity and specificity were similar, however, the positive predictive value (PPV) was higher for CPR and the negative predictive values (NPV) were similar. The AUC for CPR and UCR were 0.65 and 0.64, respectively. The CPR and UCR Z-scores performed poorly as predictors of adverse neonatal outcomes when compared with published data on using absolute CPR ratio. Our findings do not support the use of UCR Z-scores to evaluate fetuses with growth restriction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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The role of umbilical cord gas studies in the prediction of adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries

Most major societies do not state a specific recommendation against or in favor of routine umbilical cord gas studies sampling. We aimed to study the correlation between abnormal umbilical cord gas studies (using 5 different definitions) and adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries. The medical charts, surgical records, and neonatal charts of all singleton cesarean deliveries at 370/7-416/7 weeks of gestation between January 2009 and May 2018 from a single tertiary center were reviewed. The cohort of singleton cesarean deliveries was divided into those with "normal" vs "abnormal" umbilical cord gas studies with the 5 different definitions: (1) definition A: pH ≤7.15; (2) definition B: pH ≤7.15 and base excess ≤-12 mmol/L; (3) definition C: pH ≤7.1l (4) definition D: pH ≤7.1 and base excess ≤-12 mmol/L, and (5) definition E: pH <7.0 and base excess ≤-12 mmol/L. Adverse neonatal outcomes included Apgar scores at 5 minutes ≤7, neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity (presence of respiratory distress syndrome, transient tachypnea of the newborn infant, mechanical ventilation, need for respiratory support, or meconium aspiration), cerebral morbidity (presence of intraventricular hemorrhage, seizures, or hypoxic-ischemic encephalopathy), necrotizing enterocolitis, or death. Composite adverse outcome was ≥1 of the aforementioned complications. Overall, 3001 singleton cesarean deliveries were included. The rate of abnormal umbilical cord gas studies with the use of definitions A-E was 2.6%, 0.3%, 1.2%, 0.3%, and 0.1%, respectively. The overall rate of adverse neonatal outcome for the entire cohort was 14.43% (433/3001). There was no correlation between abnormal umbilical cord gas studies and composite adverse neonatal outcome with the use of any of the definitions A-E (P=.2, P=.3, P=.2, P=.3, P=.1, respectively). The sensitivity and specificity of abnormal umbilical cord gas studies as a predictor of composite adverse neonatal outcome were calculated for each of the abnormal umbilical cord gas studies definitions; although the sensitivity was extremely low (0-2.07%), the specificity was high (97.2-99.9%) CONCLUSION: Abnormal umbilical cord gas studies are an uncommon finding in cases of singleton term singleton cesarean deliveries and do not correlate with adverse neonatal outcomes. Therefore, the clinical usefulness and cost-effectiveness of obtaining these studies routinely should be questioned.

Middle Cerebral and Umbilical Arteries Doppler Indices in the Prediction of Adverse Neonatal Outcome Among Diabetic Pregnant Women

Middle Cerebral and Umbilical Arteries Doppler Indices in the Prediction of Adverse Neonatal Outcome Among Diabetic Pregnant Women

1030: Umbilical artery gas studies and the prediction of adverse neonatal outcomes in elective cesarean deliveries

1030: Umbilical artery gas studies and the prediction of adverse neonatal outcomes in elective cesarean deliveries

Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome.

To analyze if umbilical artery pH (pHua) ≤7.00 and umbilical artery blood deficit (BDua) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A-women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B-all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pHua ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21-37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35-21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03-6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29-177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20-99.60; p = 0.006). The pHua and the BDua are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia.

Arteriovenous differences in cord blood gas analysis and the prediction of adverse neonatal outcome.

The aim of this paper was to determine whether arteriovenous differences of pH and pCO2 are useful predictors of adverse neonatal outcome in acidemic neonates. An established database of 8759 term, singleton, non-anomalous neonates with validated cord gases and outcomes [Encephalopathy (Grade 2/3), Apgar <7 at five minutes and composite neonatal outcomes of neurological and systemic involvement] was used. Analysis was of the cohort of the 520 acidemic (arterial pH <7.10) neonates. Chi-square tests with odds ratio (OR), 95% CI were calculated for dichotomous cut-offs of differences; hierarchical logistic regression was used to examine the predictive performance over and above arterial pH. Arteriovenous hydrogen ion concentration ([H+ ion]) differences do not predict neonatal outcomes except low Apgar scores, and large pCO2 differences are associated with worse neonatal outcomes. Nevertheless, neonates with large arteriovenous [H+ ion] and pCO2 differences have lower arterial pH values. Hierarchical regression demonstrates that arteriovenous pCO2 differences do not add predictive value beyond arterial pH and arteriovenous [H+ ion] adds only to the prediction of low Apgar scores. Arteriovenous differences of [H+ ion] and pCO2 are not useful independent predictors of adverse neonatal outcomes in acidemic neonates.

497: Angiogenic factors vs. standard evaluation in the prediction of adverse outcome among pregnancies with suspected fetal growth restriction

Prediction of adverse neonatal outcome in growth restricted fetuses (FGR) is challenging. Currently, standard evaluation includes Doppler surveillance and repeated clinical assessments. While this management protocol identifies most anticipated complications, some cases are missed and the health-care provider’s ability to predict adverse outcome may be improved. We studied the added value of angiogenic factors in management of FGR cases for the prediction of adverse perinatal outcomes. This prospective cohort study included hospitalized women with singleton pregnancies diagnosed with FGR between 24 and 35+6 weeks’ gestation (n=58). At hospitalization blood was drawn from women for sFlt-1 and PlGF measurements. Hence, three attending maternal-fetal medicine (MFM) assessed the risk of these pregnancies to develop adverse neonatal outcome (blinded), after examining the available maternal and pregnancy data upon admission. Data presented included: Doppler surveillance, clinical data and obstetrical history. The specialists predicted the risk (1-5 scale) for adverse neonatal outcome defined as: prolong NICU hospitalization, IVH, ARDS, NEC, convulsions and death. A given score of above 2 (scale of 1-5) was considered a high predicted risk for developing a complication. A score of over 14.5 multiple of the expected median (MoM) in the sFlt-1/ PlGF ratio was defined as a high predicted risk for complication. To describe performance, receiver-operating characteristic (ROC) curves were constructed for biochemical markers and clinical prediction. Disagreement between specialists was defined as a difference of 2 points or more in a given score. Of the 58 FGR cases included, 30 were complicated by adverse neonatal outcome (52%). The predictive values of the clinical assessments and of the bio-marker ratios are presented in the Table. Areas under the curve (AUCs)are presented in the Figure. Disagreement between specialists was identified in 19 cases - 32%. In 18 (95%) of these cases the marker predicted outcome accurately. Maternal serum sFlt-1/PlGF ratio can substantially improve clinical prediction of adverse neonatal outcome in FGR management. Furthermore, these biochemical tools appear to have a unique role in cases of disagreement between MFM specialists managing these cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of the predictive value of fetal Doppler ultrasound for neonatal outcome from the 36th week of pregnancy.

Background:Early prediction of adverse neonatal outcome would be possible by Doppler impedance indices of middle cerebral artery (MCA), umbilical artery (UmA), and descending aortal artery (AO) that result in decrease neonatal morbidity and mortality rate. The aim of the present study was a determination of optimal value for the ratio of MCA to descending aorta blood flow (MCA/AO) impedance indices and its comparison with the ratio of MCA to UmA (MCA/UmA) impedance indices and their relationship with neonatal outcome.Materials and Methods:This was a prospective cohort study on 212 pregnant women with gestational age 36 weeks or more, in three hospitals in Tehran, from April 2012 to April 2013. We investigated AO, MCA, and UmA impedance indices Doppler ultrasound every 2 weeks till delivery. The mother was monitored for adverse pregnancy outcome (hypertension [HTN], fetal growth retardation, and other maternal complications) then infant birth weight, cord blood of pH, and Neonatal Intensive Care Unit (NICU) admission during the first 24 h after delivery were assessed. Finally, we investigated relationships between Doppler indices and neonatal outcomes include neonatal body weight (NBW), cord blood of pH, and NICU admission.Results:MCA/AO resistance index (RI) and MCA/AO pulsatile index (PI) showed an area under the receiver operating characteristics curve (area under the curve) of 0.905 (95% confidence interval (CI): 0.850, 0.959) and 0.818 (95% CI: 0.679, 0.956), respectively. The cutoff values for pH (≥7.2 vs. <7.2) based on MCA/AO RI and MCA/AO PI indices were 0.951 (sensitivity, 80% and specificity, 86%) and 0.853 (sensitivity, 91% and specificity, 83%), respectively. The cutoff value for NBW (≥2500 vs. <2500 g) based on MCA/UmA PI index was 1.467 (sensitivity, 73% and specificity, 63%). The cutoff value of NICU admission of child based on MCA/AO PI index was 1.114 (sensitivity, 73% and specificity, 54%).Conclusion:In the end of third-trimester pregnancies with the assessment of MCA and AO artery Doppler ultrasonography, it is possible to prevent many cases of neonatal acidosis caused by prenatal asphyxia as well as inappropriate interventions which are applied on mother. If MCA/AO PI was <0.85, the fetus needs to be evaluated further because it is at risk for acidosis.