Prediction of fetal compromise in labor

Prior, Tomas, Mullins, Edward, Bennett, Phillip and Kumar, Sailesh (2014) Prediction of fetal compromise in labor. Obstetrics and Gynecology, 123 6: 1263-1271. doi:10.1097/AOG.0000000000000292

Author Prior, Tomas
Mullins, Edward
Bennett, Phillip
Kumar, Sailesh
Title Prediction of fetal compromise in labor
Journal name Obstetrics and Gynecology   Check publisher's open access policy
ISSN 1873-233X
Publication date 2014-06-01
Year available 2014
Sub-type Article (original research)
DOI 10.1097/AOG.0000000000000292
Open Access Status Not yet assessed
Volume 123
Issue 6
Start page 1263
End page 1271
Total pages 9
Place of publication Philadelphia PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
OBJECTIVE: The majority of intrapartum fetal hypoxia occurs in uncomplicated pregnancies. Current intrapartum monitoring techniques have not resulted in a reduction in the incidence of cerebral palsy in term neonates. We report the development of a composite risk score to allow risk stratification of normal pregnancies before labor.

METHODS: Six hundred one women were recruited to this prospective observational study. All women underwent an ultrasound examination before active labor, during which fetal biometry and fetal Doppler flow resistance indices were measured. A composite risk score, amalgamating data from the umbilical artery, middle cerebral artery, and umbilical vein, was then developed and correlated with intrapartum outcomes.

RESULTS: In cases with the highest composite risk scores, the incidence of fetal compromise (the primary outcome) was 80.0% compared with just 15.3% in cases with the lowest risk scores (relative risk 5.2, 95% confidence interval 2.7-10.1). These cases were also at increased risk of cesarean delivery (53.3% compared with 3.4%, P<.001) and of developing a fetal heart rate pattern considered pathologic by National Institute for Health and Clinical Excellence criteria (P=.003). No significant variation in Apgar scores or umbilical artery pH was observed.

CONCLUSION: Intrapartum fetal compromise remains a significant global health issue. The composite risk score reported here can identify fetuses at both high risk and low risk of a subsequent diagnosis of intrapartum fetal compromise. This may enable more judicious use of current intrapartum fetal monitoring techniques, which are hampered by low specificity.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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