Intrapartum prediction of emergency delivery due to non-reassuring fetal status at 40 weeks’ gestation in low-risk pregnancies: contribution of Doppler parameters, maternal history, and intrapartum clinical characteristics

Abstract

Objective: To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies.Methods: This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks' gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).Results: From 403 included pregnancies, 18.6% (n= 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 vs. 1.30; p<0.001, and 1.61 vs. 1.78; p=0.001, respectively). There was a higher incidence of small-for-gestational-age neonates (20% vs. 10.1%; p=0.017), lower Apgar scores at the 5 th minute (9.7 vs. 9.9; p=0.006), and NICU admissions (9% vs. 3%; p=0.016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p=0.008). Conclusions:In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.

Delivery of a Fetus with a Non-Reassuring Status Is Associated with Significant Maternal Morbidity

“…The diagnosis of NRFS is associated with a significant increase in maternal complications such as blood transfusions, infection, ICU admissions, and readmissions. Historically, studies of delivery for NRFS have exclusively examined neonatal outcomes [1][2][3][4][5][6][7][8][9][10][11]. To the authors' knowledge, current medical literature revealed that less attention was given to potential adverse ma-ternal outcomes in settings of NRFS.…”

“…The study uses a large electronic database that covers an ethnically and socioeconomically diverse population. Whereas other studies have historically focused on the newborn consequences of NRFS [1][2][3][4][5][6][7][8][9][10][11], we focused on the maternal consequences. Further, our findings are actionable given current focus and the development of strategies for addressing problems such as postpartum hemorrhage [15][16][17][18][19][20], peripartum infections [25], and readmissions [26].…”

“…An important objective in the management of NRFS is the prevention of fetal acidemia. Several studies have evaluated neonatal outcomes associated with NRFS [1][2][3][4][5][6][7][8][9][10][11]. Fetal acidemia is a risk factor for the need for neonatal resuscitation and admission to the neonatal intensive care unit (ICU) [3], seizures [3], encephalopathy [12], developmental disorders, and irritability [6,13].…”

Relação cerebroplacentária como método preditor de resultados adversos perinatais: um estudo retrospectivo observacional

“…Essa relação foi descrita por Arbeille et al (1987Arbeille et al ( , 1988, e posteriormente, na década de 1990, começaram a surgir os primeiros estudos demonstrando a associação entre o cenário, no qual há aumento da impedância ao fluxo na AU e redução na ACM, e complicações perinatais (Gramellini et al, 1992;Arias, 1994;Harrington et al, 1995;Bahado-Singh et al, 1999). Tanto o IP quanto o IR podem ser usados para o cálculo dessa relação, com capacidades preditivas semelhantes de resultados adversos (Flood et al, 2014;Moreta, 2019 (Bligh et al, 2018a;Crovetto et al, 2019;Dall'Asta et al, 2019 A IG ao nascimento é o fator que mais influencia os resultados neonatais, fato este já mostrado por estudos de boa qualidade (Baschat et al, 2007;Lees et al, 2013). Baschat et al (2007) (Baschat et al, 2007;Lees et al, 2013 (MacDorman et al, 2006;Villar et al, 2006).…”