Are babies that fail to reach their genetic growth potential at increased risk of intra-partum fetal compromise?

Prior, Tomas, Paramasivam, Gowri, Bennett, Phillip and Kumar, Sailesh (2015) Are babies that fail to reach their genetic growth potential at increased risk of intra-partum fetal compromise?. Ultrasound in Obstetrics and Gynecology, 46 4: 460-464. doi:10.1002/uog.14758


Author Prior, Tomas
Paramasivam, Gowri
Bennett, Phillip
Kumar, Sailesh
Title Are babies that fail to reach their genetic growth potential at increased risk of intra-partum fetal compromise?
Journal name Ultrasound in Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0960-7692
1469-0705
Publication date 2015-01-01
Sub-type Article (original research)
DOI 10.1002/uog.14758
Volume 46
Issue 4
Start page 460
End page 464
Total pages 5
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley and Sons
Collection year 2016
Language eng
Formatted abstract
Objective
Assessment of fetal haemodynamics, specifically umbilical and middle cerebral artery Doppler, can identify babies at increased risk of a subsequent diagnosis of intra-partum fetal compromise. The true growth potential of a fetus is difficult to predict, but recently a new definition, independent of fetal weight, using the cerebro-umbilical (C/U) ratio <0.6765MoM was reported. Here, we applied this definition to a prospectively recruited cohort of low risk pregnancies, to determine if babies with a C/U ratio <0.6765 are at increased risk of developing signs of intra-partum fetal compromise.

Methods
Recruitment to this prospective observational study took place between March 2011 and March 2014. All women with low risk, singleton pregnancies at term were eligible. Women with known or suspected placental dysfunction were specifically excluded. All participants underwent an ultrasound scan prior to active labour (≤4 cm) labour, during which fetal biometry, umbilical artery and middle cerebral artery blood flow was assessed. Following delivery, intra-partum and neonatal outcomes were compared between babies with a C/U <0.6765MoM and those with a C/U ratio ≥0.6765MoM.

Results
Seven hundred and seventy five women were recruited to the study. Fetuses with a C/U ratio <0.6765MoM were significantly more likely to require Caesarean delivery for presumed fetal compromise (p < 0.001). These fetuses were also at increased risk of a diagnosis of fetal compromise at any time during labour, and less likely to achieve an SVD or a vaginal delivery of any other kind than those with a C/U ratio ≥0.6765MoM. A C/U ratio <0.6765MoM gave a positive predictive value (PPV) for Caesarean delivery for presumed fetal compromise of 36.7%, with a sensitivity of 18% and a specificity of 95.4%.

Conclusion
Babies that failed to reach their genetic growth potential (defined as a C/U ratio <0.6765MoM) were at increased risk of a diagnosis of intra-partum fetal compromise, and less likely to be delivered vaginally. A C/U ratio <0.6765MoM yielded a similar positive predictive value for Caesarean section for presumed fetal compromise as a C/U ratio <10th centile, however, the negative predictive value of a C/U ratio ≥0.6765MoM for fetal compromise was poor.
Keyword Growth potential
Cerebro umbilical ratio
Cerebro placental ratio
Fetal Doppler
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 5 times in Scopus Article | Citations
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Created: Wed, 24 Jun 2015, 15:43:20 EST by Sailesh Kumar on behalf of Obstetrics & Gynaecology - Mater Hospital