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Morales-Roselló J, Loscalzo G, Gallego A, Jakaitė V, Perales-Marín A. Which is the best ultrasound parameter for the prediction of adverse perinatal outcome within 1 day of delivery? J Matern Fetal Neonatal Med 2021; 35:8571-8579. [PMID: 34634978 DOI: 10.1080/14767058.2021.1989401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the accuracies of several sonographic parameters for the prediction of adverse perinatal outcome (APO) prior to delivery. METHODS This was a prospective study of fetuses attending the day hospital unit of a tertiary referral hospital that were scanned at 34-41 weeks and gave birth within 24 h of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH < 7.20 requiring urgent cesarean section, neonatal umbilical cord pH < 7.10, 5' Apgar score <7 and postpartum admission to neonatal or pediatric intensive care units. The accuracies of the middle cerebral, vertebral and umbilical arteries pulsatility index multiples of the median (MoM), the cerebroplacental and vertebroplacental ratios MoM and the EFW in centiles for the prediction of APO was evaluated by means of ROC curves and logistic regression analysis. RESULTS A total of 2140 fetuses were prospectively scanned, however only 182 entered into spontaneous or induced labor and were delivered within 24 h of examination. In this group, MCA PI MoM was the best predictor of APO (AUC = 0.76, 95% CI 0.66-0.85, p < .0001) followed by the CPR MoM (AUC = 0.73, 95% CI 0.63-0.84, p < .0001) and the VPR MoM (AUC = 0.71, 95% CI 0.61-0.81, p < .001). Logistic regression analysis indicated that MCA PI MoM was the only independent determinant for the prediction of APO. CONCLUSION In a high-risk population of third-trimester fetuses delivering within 24 h of examination, the outcome may be moderately anticipated just with the information provided by the cerebral flow.
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Affiliation(s)
- José Morales-Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Gallego
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vaidilė Jakaitė
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alfredo Perales-Marín
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
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Chamagne M, Beffara F, Patte C, Vigouroux C, Renevier B. [Management of fetal growth restriction in France: Survey of teaching hospitals and tertiary referral centers]. ACTA ACUST UNITED AC 2021; 49:756-762. [PMID: 33887529 DOI: 10.1016/j.gofs.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES French Guidelines on Fetal Growth Restriction (FGR) were published in December 2013. It seemed interesting to us to carry out an inventory on the management of FGR in teaching hospitals and tertiary referral centers MATERIAL AND METHODS: We carried out a retrospective survey on the academic year 2020/2021. All teaching hospitals and level III maternity in mainland France were contacted (67). The questionnaire focused on the growth curves used, the etiological assessment carried out, the rate and modalities of antenatal surveillance as well as the criteria indicating a birth. RESULTS The response rate was 76%. The CFEF curves are used for screening in 78.4% of centers and in the event of FGR in 39.2% of them. The etiological assessment includes a referent ultrasound in 62.7% of cases and amniocentesis is offered in 74.5% of hospitals in case of severe and early FGR. All centers use umbilical Doppler for FGR. The fetal heart rate is monitored between once a week to three times a day in the event of cerebro-placental redistribution. In case of reverse flow, birth is induced from 28 weeks on for some teams while others continue the pregnancy until 39 weeks. In case of cessation of fetal growth, the expected terms of birth are between 28 and 38 weeks. CONCLUSION There is great heterogeneity in the management of FGR, particularly in terms of antenatal surveillance and the term of birth envisaged.
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Affiliation(s)
- M Chamagne
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France.
| | - F Beffara
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
| | - C Patte
- Service de gynécologie obstétrique, CHU de Nancy, 10, avenue du Dr Heydenreich, 54000 Nancy, France
| | - C Vigouroux
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
| | - B Renevier
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
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Morales-Roselló J, Buongiorno S, Loscalzo G, Abad García C, Cañada Martínez AJ, Perales Marín A. Does Uterine Doppler Add Information to the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome at the End of Pregnancy? Fetal Diagn Ther 2019; 47:34-44. [PMID: 31137027 DOI: 10.1159/000499483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether the addition of the mean uterine arteries pulsatility index (mUtA PI) to the cerebroplacental ratio (CPR) improves its ability to predict adverse perinatal outcome (APO) at the end of pregnancy. METHODS This was a prospective study of 891 fetuses that underwent an ultrasound examination at 34-41 weeks. The CPR and the mUtA PI were converted into multiples of the median (MoM) and the estimated fetal weight (EFW) into centiles according to local references. APO was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean section, 5' Apgar score <7, neonatal pH <7.10 and admission to pediatric care units. The accuracies of the different parameters were evaluated alone and in combination with gestational characteristics using univariate and multivariate analyses by means of the Akaike Information Criteria (AIC) and the area under the curve (AUC). Finally, a comparison was similarly performed between the CPR and the cerebro-placental-uterine ratio (CPUR; CPR/mUtA PI) for the prediction of APO. RESULTS The univariate analysis showed that CPR MoM was the best parameter predicting APO (AIC 615.71, AUC 0.675). The multivariate analysis including clinical data showed that the best prediction was also achieved with the CPR MoM (AIC 599.39, AUC 0.718). Moreover, when EFW centiles were considered, the addition of UtA PI MoM did not improve the prediction already obtained with CPR MoM (AIC 591.36, AUC 0.729 vs. AIC 589.86, AUC 0.731). Finally, the prediction by means of CPUR did not improve that of CPR alone (AIC 623.38, AUC 0.674 vs. AIC 623.27, AUC 0.66). CONCLUSION The best prediction of APO at the end of pregnancy is obtained with CPR whatever is the combination of parameters. The addition of uterine Doppler to the information yielded by CPR does not result in any prediction improvement.
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Affiliation(s)
- José Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain, .,Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain,
| | - Silvia Buongiorno
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Cristina Abad García
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Alfredo Perales Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
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Morales-Roselló J, Cañada Martínez AJ, Scarinci E, Perales Marín A. Comparison of Cerebroplacental Ratio, Intergrowth-21st Standards, Customized Growth, and Local Population References for the Prediction of Fetal Compromise: Which Is the Best Approach? Fetal Diagn Ther 2019; 46:341-352. [PMID: 31013504 DOI: 10.1159/000497142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to compare the accuracy of the cerebroplacental ratio (CPR), Intergrowth 21st standards (IG21), customized growth (CG), and local population references (LPR) in the prediction of intrapartum fetal compromise (IFC). METHODS This was a prospective study of 714 fetuses that underwent an ultrasound examination at 34-41 weeks and were delivered within a 2-week interval. The CPR was converted into multiples of the median and the estimated fetal weight (EFW) transformed into CG, IG21, and LPR centiles. IFC was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean section, 5-min Apgar score, and admission to pediatric care units. The accuracies of the CPR and the EFW centiles for the prediction of IFC were evaluated alone and in combination with other gestational characteristics using univariate and multivariate analysis. RESULTS Individually, the CPR was the parameter that best predicted the existence of IFC (AUC = 0.66). The multivariate analysis showed that the best prediction was again achieved with the CPR, alone or in combination with any of the EFW centiles (AUC = 0.74). No significant differences were seen between the different centile methods. CONCLUSION The best prediction of IFC is obtained with CPR. Evaluation of CPR should be encouraged in term and late-preterm fetuses.
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Affiliation(s)
- José Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain, .,Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain,
| | | | - Elisa Scarinci
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
| | - Alfredo Perales Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
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Li J, Cai A, Yuan Q, Ding H, Zhao D. Relationships of serum placental growth factor and soluble fms-like tyrosine kinase-1 with fetal and uterine artery Doppler indices in pre-eclampsia. Int J Gynaecol Obstet 2019; 145:176-181. [PMID: 30801711 DOI: 10.1002/ijgo.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) concentrations among women with pre-eclampsia and healthy control women and to evaluate the associations of serum PlGF and sFlt-1 with fetal and uterine artery Doppler indices in pre-eclampsia. METHODS A prospective cross-sectional study of 33 women with pre-eclampsia and 33 normotensive pregnant women attending a university hospital in China between January and November 2014. Serum PlGF and sFlt-1 were assayed by enzyme linked immunosorbent assays. Doppler indices of the uterine artery, umbilical artery, fetal middle cerebral artery, and ductus venosus were measured. RESULTS The pulsatility index of the uterine artery was negatively correlated with PlGF (r, -0.487; P=0.004) and positively correlated with sFlt-1 (r, 0.420; P=0.015). Gestational age at birth was positively correlated with PlGF (r, 0.601, P<0.001) and negatively correlated with sFlt-1 (r, -0.568; P=0.001). Birth weight was positively correlated with PlGF (r, 0.555; P=0.001) and negatively correlated with sFlt-1 (r, -0.552; P=0.001). Apgar score was negatively correlated with sFlt-1 (r, -0.427; P=0.017). CONCLUSION Lower PlGF and higher sFlt-1 levels in maternal serum were significantly associated with increased uterine arterial impedance in pre-eclampsia.
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Affiliation(s)
- Jingyu Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qian Yuan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hao Ding
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Andıç E, Karaman E, Kolusarı A, Çokluk E. Association of cord blood ischemia-modified albumin level with abnormal foetal Doppler parameters in intrauterine growth-restricted foetuses. J Matern Fetal Neonatal Med 2019; 34:1-6. [PMID: 30691329 DOI: 10.1080/14767058.2019.1569623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To investigate cord blood ischemia-modified albumin (IMA) levels in pregnancies with intrauterine growth restriction (IUGR) and to determine its association with abnormal fetal Doppler findings.Methods: Umbilical cord IMA levels were assessed in 34 pregnant women with IUGR and 32 pregnancies with normal fetal development. Associations of IMA with abnormal umbilical artery Doppler findings, preeclampsia, and oligohydramnios were investigated. IMA was measured using a colorimetric test based on a decrease in cobalt binding.Results: No significant between group differences in maternal age, body mass index, gravida, and parity were identified. The mean gestational age at delivery was earlier in the IUGR group than in the control group (35.7 ± 3.2 versus 38.4 ± 1.2, respectively). The mean cord blood IMA values for the IUGR group were significantly increased compared to those in the control group (0.565 ± 0.22 versus 0.250 ± 0.12, respectively, p = .001). There was a significant positive correlation between umbilical artery pulsatility index and IMA levels in the IUGR group. Patients with preeclampsia, oligohydramnios, and abnormal nonstress test results in the IUGR group had significantly higher IMA levels. Patients with systolic to diastolic ratios >3 and pulsatility index (PI) above the 95th percentile in the IUGR group had significantly higher cord blood IMA levels (p = .001 and p = .007, respectively).Conclusions: Cord blood IMA values may be a useful marker for perinatal asphyxia. Abnormal Doppler findings are associated with increased IMA levels in complicated pregnancies with IUGR.
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Affiliation(s)
- Esra Andıç
- Department of Obstetric and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Erbil Karaman
- Department of Obstetric and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Ali Kolusarı
- Department of Obstetric and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Erdem Çokluk
- Department of Biochemistry, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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Abstract
Background Sexual dimorphism in placental size and function has been described. Whether this influences the clinically important umbilical artery (UA) waveform remains controversial, although a few cross-sectional studies have shown sex differences in UA pulsatility index (PI). Therefore, we tested whether fetal sex influences the UA Doppler indices during the entire second half of pregnancy and aimed to establish sex-specific reference ranges for UA Doppler indices if needed. Methods Our main objective was to investigate gestational age-associated changes in UA Doppler indices during the second half of pregnancy and compare the values between male and female fetuses. This was a prospective longitudinal study in women with singleton low-risk pregnancies during 19–40 weeks of gestation. UA Doppler indices were serially obtained at a 4-weekly interval from a free loop of the umbilical cord using color-directed pulsed-wave Doppler ultrasonography. Sex-specific reference intervals were calculated for the fetal heart rate (HR), UA PI, resistance index (RI), and systolic/diastolic ratio (S/D) using multilevel modeling. Results Complete data from 294 pregnancies (a total of 1261 observations from 152 male and 142 female fetuses) were available for statistical analysis, and sex-specific reference ranges for the UA Doppler indices and fetal HR were established for the last half of pregnancy. UA Doppler indices were significantly associated with gestational age (P < 0.0001) and fetal HR (P < 0.0001). Female fetuses had 2–8% higher values for UA Doppler indices than male fetuses during gestational weeks 20+0–36+6 (P < 0.05), but not later. Female fetuses had higher HR from gestational week 26+0 until term (P < 0.05). Conclusions We have determined gestational age-dependent sex differences in UA Doppler indices and fetal HR during the second half of pregnancy, and correspondingly established new sex-specific reference ranges intended for refining diagnostics and monitoring individual pregnancies.
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Affiliation(s)
- Christian Widnes
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway. .,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway.
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway
| | - Torvid Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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8
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Abstract
Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.
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Affiliation(s)
- Andrea Dall’Asta
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Valentina Brunelli
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Christoph C Lees
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Development and Regeneration, KU Leuven, Belgium
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Mgaya AH, Litorp H, Kidanto HL, Nyström L, Essén B. Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania. BMC Pregnancy Childbirth 2016; 16:343. [PMID: 27825311 DOI: 10.1186/s12884-016-1137-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting. METHODS During 2013-2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for standard diagnosis and management of foetal distress were developed based on international and national guidelines, and literature reviews, and then, stepwise applied, in an audit cycle. During the baseline audit, substandard care was identified, and recommendations for improvement of care were proposed and implemented. The effect of the implementations was assessed by the differences in percentage of standard diagnosis and management between the baseline and re-audit, using Chi-square test or Fisher's exact test, when appropriate. RESULTS In the baseline audit and re-audit, 248 and 251 deliveries with a diagnosis of foetal distress were identified and audited, respectively. The standard of diagnosis increased significantly from 52 to 68 % (p < 0.001). Standards of management improved tenfold from 0.8 to 8.8 % (p < 0.001). Improved foetal heartbeat monitoring using a Fetal Doppler was the major improvement in diagnoses, while change of position of the mother and reduced time interval from decision to perform caesarean section to delivery were the major improvements in management (all p < 0.001). Percentage of cases with substandard diagnosis and management was significantly reduced in both referred public and non-referred private patients (all p ≤ 0.01) but not in non-referred public and referred private patients. CONCLUSION The criteria-based audit was able to detect substandard diagnosis and management of foetal distress and improved care using feedback and available resources.
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Candel Pau J, Castillo Salinas F, Perapoch López J, Carrascosa Lezcano A, Sánchez García O, Llurba Olivé E. [Perinatal outcome and cardiac dysfunction in preterm growth-restricted neonates in relation to placental impairment severity]. An Pediatr (Barc) 2015; 85:170-180. [PMID: 25982472 DOI: 10.1016/j.anpedi.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intrauterine growth restriction (IUGR) and prematurity have been associated with increased perinatal morbidity and mortality and also with cardiovascular foetal programming. However, there are few studies on the impact of placenta-related IUGR on perinatal outcomes and cardiovascular biomarkers in pre-term infants. OBJECTIVES To determine differences in neonatal morbidity, mortality and cord blood biomarkers of cardiovascular dysfunction between pre-term placenta-related IUGR and non-IUGR new-borns, and to analyse their relationship with the severity of IUGR according to foetal Doppler evaluation. MATERIAL AND METHODS Prospective cohort study: pre-term infants with placenta-related IUGR and matched pre-term infants without IUGR. A Doppler scan was performed, and placenta-IUGR was classified according to severity. Comparative analysis of perinatal outcomes, neonatal morbidity and mortality, and cord blood levels of biomarkers of cardiovascular dysfunction was performed. RESULTS IUGR new-borns present lower weight, length, head circumference, and Apgar score at birth, as well as increased neonatal and cardiovascular dysfunction biomarker levels, compared with pre-term new-borns without IUGR. These differences increase with the severity of IUGR determined by prenatal umbilical artery Doppler scan. CONCLUSIONS Placenta-related-IUGR pre-term infants, irrespective of gestational age, present increased neonatal morbidity and mortality that is significantly proportional to the severity of IUGR. Placental impairment and severity also determine levels of cardiovascular dysfunction biomarkers at birth.
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Affiliation(s)
- Júlia Candel Pau
- Fundación Institut de Recerca de la Vall d'Hebron (VHIR), Barcelona, España.
| | - Félix Castillo Salinas
- Servicio de Neonatología, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - Josep Perapoch López
- Servicio de Neonatología, Hospital Universitario Vall d'Hebron, Barcelona, España; Red de Salud Materno Infantil y del Desarrollo (RED SAMID), Barcelona, España
| | - Antonio Carrascosa Lezcano
- Servicio de Pediatría y Endocrinología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España; CIBERER, Barcelona, España
| | - Olga Sánchez García
- Fundación Institut de Recerca de la Vall d'Hebron (VHIR), Barcelona, España; Red de Salud Materno Infantil y del Desarrollo (RED SAMID), Barcelona, España
| | - Elisa Llurba Olivé
- Servicio de Obstetricia y Ginecología, Hospital Universitario Vall d'Hebron, Barcelona, España; Red de Salud Materno Infantil y del Desarrollo (RED SAMID), Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
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11
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Seravalli V, Block-Abraham DM, Turan OM, Doyle LE, Kopelman JN, Atlas RO, Jenkins CB, Blitzer MG, Baschat AA. First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics. Am J Obstet Gynecol 2014; 211:261.e1-8. [PMID: 24631442 DOI: 10.1016/j.ajog.2014.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 02/16/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction. STUDY DESIGN Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant. RESULTS Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free β-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P < .001) and UA pulsatility index z-scores (P = .03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P < .001), PAPP-A multiple of the median and bilateral notching (P < .05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores. CONCLUSION Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.
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Affiliation(s)
- Viola Seravalli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Dana M Block-Abraham
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Lauren E Doyle
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Jerome N Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Robert O Atlas
- Department of Obstetrics and Gynecology, Mercy Medical Center, Baltimore, MD
| | - Chuka B Jenkins
- Department of Obstetrics and Gynecology, MedStar Harbor Hospital and Franklin Square Hospital Medical Centers, Baltimore, MD
| | - Miriam G Blitzer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Ahmet A Baschat
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
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