Blinded comparison of doppler velocimetry and modified biophysical profile in the iugr fetus

F. Gattousis, R. Bonebrake, T. Atrat, Craig Towers, M. Nageotte

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To compare, in a blinded fashion, the ability of" umbilical artery Doppler to that of the modified biophysical profile (MBPP=2X weekly NST+AFI) to predict adverse outcomes in a known IUGR fetus with birthweight <3rd percentile. STUDY DESIGN: Umbilical artery Doppler data were collected at the time of antepartum fetal heart rate testing. The Doppler results were blinded and categorically not used in the clinical management of patients. Inclusion criteria consisted of those tested for a clinical suspicion of IUGR, had a MBPP and umbilical arteiy Doppler study as their last test, and a birthweight <3rd %ile. Adverse outcome was defined as admission to the NICU (for reasons other than birthweight), meconiurn passage, 5 minute Apgar <7, antenatal cesarean section, cesarean section for fetal distress within the first two hours of labor, umbilical arten- pH <7.2, antepartum, or neonatal death. RESULTS: 53 patients were evaluated with birthweights <3rd %ile. There were no antepartum or neonatal deaths. The overall sensitivity and PPV of Doppler analysis to predict a fetus with any adverse outcome was 36 and 41 %, respectively; and that of the MBPP was 44 and 50%, respectively. Combining the two modalities increased the sensitivity to 71%; however, decreased the PPV to 41%. There were no differences in outcome between those with normal and abnormal Doppler results when both grotips had a normal MBPP. Fetuses in the group with both abnormal tests had higher incidences of cesarean section for fetal distress, lower umbilical arten' pH's, and greater chances of having an adverse outcome. When the MBPP was abnormal, the gestational age at deliver)' was earlier (38.1 ±3.3 vs 35.±2.6 wks) with an increase in adverse outcomes in the group with abnormal Doppler. CONCLUSIONS: Within a strictly defined cohort of growth restricted fetuses (<3rd %ile), umbilical arten Doppler velocimetry does not appear to offer any improvement in detecting the fetus at risk for an adverse outcome when there is a normal MBPP. Furthermore, the use of Doppler in combination with the MBPP may decrease the PPV; thereby, increasing the risk of unnecessary intervention and iatragenic prematurity.

Original languageEnglish (US)
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - 1997
Externally publishedYes

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Rheology
Umbilicus
Fetus
Cesarean Section
Fetal Distress
Umbilical Arteries
Fetal Growth Retardation
Fetal Heart Rate
Gestational Age
Incidence
Growth
Perinatal Death

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Blinded comparison of doppler velocimetry and modified biophysical profile in the iugr fetus. / Gattousis, F.; Bonebrake, R.; Atrat, T.; Towers, Craig; Nageotte, M.

In: Acta Diabetologica Latina, Vol. 176, No. 1 PART II, 1997.

Research output: Contribution to journalArticle

Gattousis, F, Bonebrake, R, Atrat, T, Towers, C & Nageotte, M 1997, 'Blinded comparison of doppler velocimetry and modified biophysical profile in the iugr fetus', Acta Diabetologica Latina, vol. 176, no. 1 PART II.
Gattousis, F. ; Bonebrake, R. ; Atrat, T. ; Towers, Craig ; Nageotte, M. / Blinded comparison of doppler velocimetry and modified biophysical profile in the iugr fetus. In: Acta Diabetologica Latina. 1997 ; Vol. 176, No. 1 PART II.
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AU - Atrat, T.

AU - Towers, Craig

AU - Nageotte, M.

PY - 1997

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N2 - OBJECTIVE: To compare, in a blinded fashion, the ability of" umbilical artery Doppler to that of the modified biophysical profile (MBPP=2X weekly NST+AFI) to predict adverse outcomes in a known IUGR fetus with birthweight <3rd percentile. STUDY DESIGN: Umbilical artery Doppler data were collected at the time of antepartum fetal heart rate testing. The Doppler results were blinded and categorically not used in the clinical management of patients. Inclusion criteria consisted of those tested for a clinical suspicion of IUGR, had a MBPP and umbilical arteiy Doppler study as their last test, and a birthweight <3rd %ile. Adverse outcome was defined as admission to the NICU (for reasons other than birthweight), meconiurn passage, 5 minute Apgar <7, antenatal cesarean section, cesarean section for fetal distress within the first two hours of labor, umbilical arten- pH <7.2, antepartum, or neonatal death. RESULTS: 53 patients were evaluated with birthweights <3rd %ile. There were no antepartum or neonatal deaths. The overall sensitivity and PPV of Doppler analysis to predict a fetus with any adverse outcome was 36 and 41 %, respectively; and that of the MBPP was 44 and 50%, respectively. Combining the two modalities increased the sensitivity to 71%; however, decreased the PPV to 41%. There were no differences in outcome between those with normal and abnormal Doppler results when both grotips had a normal MBPP. Fetuses in the group with both abnormal tests had higher incidences of cesarean section for fetal distress, lower umbilical arten' pH's, and greater chances of having an adverse outcome. When the MBPP was abnormal, the gestational age at deliver)' was earlier (38.1 ±3.3 vs 35.±2.6 wks) with an increase in adverse outcomes in the group with abnormal Doppler. CONCLUSIONS: Within a strictly defined cohort of growth restricted fetuses (<3rd %ile), umbilical arten Doppler velocimetry does not appear to offer any improvement in detecting the fetus at risk for an adverse outcome when there is a normal MBPP. Furthermore, the use of Doppler in combination with the MBPP may decrease the PPV; thereby, increasing the risk of unnecessary intervention and iatragenic prematurity.

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