Combination of second-trimester serum inhibin-A and uterine artery Doppler at 20 weeks improves the screening efficacy for the prediction of pre-eclampsia especially when this necessitates early delivery. This combination might form the basis of an effective and practical early screening test for the condition.

No abstract

At 20 weeks' gestation, bilateral notches with mean RI cut-offs is the best screening method if further screening later in pregnancy is proposed. The A/C ratio is complementary to bilateral notches when the false-positive rate is set at 17% and an effective quantitative substitute when the false-positive rate is set at 11%.

A complaint of decreased fetal movements is a common indication for the assessment of fetal well being. The aim of this study was to review the outcome of a group of women whose primary indication for referral was decreased fetal movements. Over a 20 month period, 435 patients were seen in the fetal assessment unit of an inner London teaching hospital, following a primary complaint of reduced fetal movements. Investigations included: the fetal abdominal circumference (AC), amniotic fluid volume (AFV), the umbilical artery pulsatility index (UAPI) derived from Doppler ultrasound waveforms and a computerised analysis of fetal heart rate (FHR) recordings or cardiotocograph (CTG). Outcome measures were: gestational age at delivery, Apgar score < 7 at 5 minutes, admission to the Special Care Baby Unit (SCBU), the need for delivery by an emergency cesarean section for fetal compromise (CSFC), and any perinatal deaths. A comparison of actual versus expected outcome for women with decreased fetal movement revealed the following relative risks, with the 95% confidence intervals (CI) in brackets; low 5 minute Apgar score 0.03 vs. 0.05 expected (CI = 0.01, 0.05), SCBU admission, 0.06 vs. 0.07 (0.04, 0.08), and preterm delivery, 0.08 vs. 0.11 (0.05, 0.10). Cesarean sections for fetal compromise, 0.07 vs. 0.053 (0.050-0.096). The addition of FHR monitoring to standard ultrasound assessment of well being did not appear to confer any added benefit. There were no fetal deaths. The outcome for pregnancies where the mother presents with decreased fetal movements in the third trimester is comparable with the outcome for the general population.