Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses
| Autor: | Gunvor Ekman, Alf Maesel, Ulf Ulmsten, Karel Marsal, Ove Axelsson, Sven Cnattingius, Kjell Arström, Harald Almström |
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| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cardiotocography Ultrasonography Prenatal Umbilical Arteries Pregnancy medicine.artery Intensive care medicine Fetal distress Humans Prospective Studies Gynecology Small for gestational age fetus Fetal Growth Retardation medicine.diagnostic_test business.industry Obstetrics Infant Newborn Obstetrics and Gynecology Gestational age Umbilical artery General Medicine Velocimetry medicine.disease Apgar Score Small for gestational age Female Apgar score business |
| Zdroj: | The Lancet. 340:936-940 |
| ISSN: | 0140-6736 |
| DOI: | 10.1016/0140-6736(92)92818-z |
| Popis: | Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography. |
| Databáze: | OpenAIRE |
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