Moderate Asph?xia in Intrauterine Growth Restriction of the Fetus - Cardiotocography and Ultrasound Methods of Diagnosis

Elena Pirnareva, Borislav Marinov

Abstract


Asphyxia remains an important cause for neonatal morbidity and mortality. The tests in themselves cardiotocography (NST), sonography, Doppler studies which are used for antenatal fetus surveillance are aimed at timely diagnosing the signs of the fetus asphyxia. The objective of the current research is to study which modifications in the cardiotocography (NST), arterial and venosus Doppler correlate most strongly with moderate asphyxia pH< 7.20 and base excess (BE) < - 12 mmol/l, regarding pregnancies which are complicated with intrauterine growth restriction of the fetus. At delivery totally 32 are the cases with moderate fetus asphyxia pH < 7.20 and BE < - 12 mmol/l. Loss in reactivity in the non-stress test shows sensitivity 76.9%, specifity 46%, positive predictive value (PPV) 12.8%, negative predictive value (NPV) 95.1%, odds ratio (OR) 2.84, p< 0.051.

The presence of spontaneous decelerations in the cardiotocography shows sensitivity 26.7%, specificity 87.1%, PPV 21.1, NPV 90.2%, odds ratio (OR) 2.45, p< 0.166, the elevated pulsatility index of umbilical artery shows sensitivity 14.3%, specificity 50%, PPV 3.1%, .NPV 83.8%, OR 0.17, p< 0.022, absent end-diastolic velocity of the umbilical artery shows sensitivity 84.6%, specificity 60.3%, PPV 18%, NPV 97.4%, OR 84, p < 0.007, the elevated pulsatility index for veins (PIV) shows sensitivity 7.1%, specificity 52.8%, PPV 1.7% , NPV 83.5% OR 0.09, p < 0.020, reversed a-wave ductus venosus shows sensitivity 75%, specificity 39.4%, PPV 10.5% NPV 94.3% OR 1.9, p< 0.334. Concerning pregnant women with intrauterine growth restriction of the fetus the prognostication of moderate fetus asphyxia at delivery pH < 7.20 and BE< - 12 mmol/l with the highest specificity of antenatal testing is the absent end-diastolic blood velocity of umbilical artery and the reversed a-wave ductus venosus in Doppler studies.


Keywords


fetus asphyxia at delivery; intrauterine growth restriction of the fetus.

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References


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