Prelabor and intrapartum Doppler ultrasound to predict fetal compromise

Dall’Asta, A.; Kumar, Sailesh

doi:10.1016/j.ajogmf.2021.100479

Cited by 12 publications

(13 citation statements)

References 119 publications

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“…[59][60][61][62][63][64] If these episodes of hypoxaemia continue, fetal cardiac output is progressively compromised, leading to fetal hypotension and hypoperfusion, potentially resulting in hypoxic-ischemic brain injury. [65][66][67][68][69][70][71] The progressive worsening intrapartum fetal hypoxaemia can be observed as changes in baseline FHR and deeper FHR decelerations, 6,72,73 but once deeper decelerations are established there is typically little further change in FHR. 74 Increased FHRV typically develops in the early stage of fetal hypoxia 23,29,36,43 but can be seen also in FHR tracings of fetuses during the preterminal stage of repeated asphyxia (Appendix S1).…”

Section: Feta L a Da P Tat Ion Du R I Ng L A Bou Rmentioning

confidence: 99%

“…However, if the interval between the contractions is too short, or placental function is compromised, prolonged impairment of oxygen delivery may lead to tissue hypoxia, metabolic acidaemia, and persistent reduction in fetal cerebral oxygenation 59–64 . If these episodes of hypoxaemia continue, fetal cardiac output is progressively compromised, leading to fetal hypotension and hypoperfusion, potentially resulting in hypoxic–ischemic brain injury 65–71 . The progressive worsening intrapartum fetal hypoxaemia can be observed as changes in baseline FHR and deeper FHR decelerations, 6,72,73 but once deeper decelerations are established there is typically little further change in FHR 74 .…”

Section: Fetal Adaptation During Labourmentioning

confidence: 99%

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Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies

Tarvonen

Lear

Andersson

et al. 2022

BJOG

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Increased fetal heart rate variability (FHRV) in intrapartum cardiotocographic recording has been variably defined and poorly understood, limiting its clinical utility. Both preclinical (animal) and clinical (human) evidence support that increased FHRV is observed in the early stage of intrapartum fetal hypoxaemia but can also be observed in a subset of fetuses during the preterminal stage of repeated hypoxaemia. This review of available evidence provides data and expert opinion on the pathophysiology of increased FHRV, its clinical significance and a stepwise approach regarding the management of this pattern, and propose recommendations for standardisation of related terminology.

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Section: Feta L a Da P Tat Ion Du R I Ng L A Bou Rmentioning

confidence: 99%

Section: Fetal Adaptation During Labourmentioning

confidence: 99%

Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies

Tarvonen

Lear

Andersson

et al. 2022

BJOG

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“…Several studies have attempted to predict the failed SVD with antepartum ultrasound parameters, including fetal head circumference (12), cervical length (13)(14)(15), subpubic angle (12,13), and angle of progression (16). However, these indicators seem to have lower predictive accuracy than intrapartum ultrasound (17), partially because the predictors included in their prediction models were detected in the third trimester, and the relatively large time interval between the ultrasound examination and delivery leads to unsatisfactory performance.…”

Section: Introductionmentioning

confidence: 99%

Nomogram based on the final antepartum ultrasound features before delivery for predicting failed spontaneous vaginal delivery in nulliparous women

et al. 2023

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BackgroundAccurate identification of nulliparous women with failed spontaneous vaginal delivery (SVD) is crucial to minimize the hazards associated with obstetrical intervention (OI). While abnormal labor progression can be identified with intrapartum ultrasonography, labor-related complications may be unavoidable due to the limited time window left to the obstetrician. Antepartum ultrasound enables sufficient obstetric planning. However, there is typically a longer gap between ultrasound assessment and delivery that often lowers the prediction accuracy compared to intrapartum ultrasonography.ObjectiveIn this study, antepartum ultrasound assessment was included to each fetal ultrasound examination after 36 weeks of gestation until the onset of labor. We aim to establish a nomogram to predict the likelihood of failed SVD in nulliparous women using the last antepartum ultrasound findings before labor beginning.MethodsOf the 2,143 nulliparous women recruited, 1,373 were included in a training cohort and 770 in a validation cohort, based on their delivery date. Maternal and perinatal characteristics, as well as perinatal ultrasound parameters were collected. In the training cohort, the screened correlates of SVD failure were used to develop a nomogram for determining whether a nulliparous woman would experience SVD failure. This model was validated in both training and validation cohorts.ResultsSVD failure affected 217 nulliparous women (10.13%). In the training cohort, SVD failure was independently associated with BMI [odds ratio (OR) = 1.636], FHC (OR = 1.194), CL (OR = 1.398), and PCA (OR = 0.824) (all P < 0.05). They constituted a nomogram to estimate the individual risk of SVD failure. The model obtained clinical net benefits in both the training and validation cohorts and was validated to present strong discrimination and calibration.ConclusionThe developed nomogram based on the last antepartum ultrasound findings may be helpful in avoiding OI and its related complications by assessing the likelihood of a failed SVD in nulliparous women.

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“…[3][4][5][6] In contrast, the intrapartum Doppler assessment has shown no benefit in perinatal outcomes. 7 Differentiated normal and abnormal sonographic postpartum findings can also be an extra implement for the patients' well-being when the clinical evaluations are doubtful. 8 Despite great acceptability by patients, 9 specially during stressful situations such as prolonged labor (more than 12 hours from the beginning of active phase of the first stage) and unplanned operative delivery, 10 the use of intrapartum ultrasound requires a steep learning curve for good reproducibility; thus, younger obstetricians prefer to rely on clinical and digital examinations, 11,12 even though ultrasound has been proven to be more reliable than VE.…”

Section: Introductionmentioning

confidence: 99%

“… 3 4 5 6 In contrast, the intrapartum Doppler assessment has shown no benefit in perinatal outcomes. 7 …”

Section: Introductionmentioning

confidence: 99%

How to Reach the Best Ultrasound Performance in the Delivery Room

Santana

Castello

Passos

et al. 2022

Rev Bras Ginecol Obstet

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Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.

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Prelabor and intrapartum Doppler ultrasound to predict fetal compromise

Cited by 12 publications

References 119 publications

Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies

Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies

Nomogram based on the final antepartum ultrasound features before delivery for predicting failed spontaneous vaginal delivery in nulliparous women

How to Reach the Best Ultrasound Performance in the Delivery Room

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