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Umbilical venous flow rate in term fetuses: can variations in flow predict intrapartum compromise?
MedLine Citation:
PMID:  23999417     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the distribution of umbilical venous flow rates, measured in early labour, in a cohort of normal term pregnancies, and to establish the relationship between umbilical venous flow and subsequent intra-partum outcome.
STUDY DESIGN: Five hundred and eighty nine women with uncomplicated, term, singleton pregnancies, were recruited to this prospective observational study prior to active labour (≤4cm dilation), at Queen Charlotte's and Chelsea Hospital, London. All participants underwent an ultrasound examination, during which fetal biometry, umbilical venous flow velocity, and umbilical vein diameter were recorded. Umbilical venous flow rate was then calculated. Following delivery, intra-partum and neonatal outcomes were correlated with the ultrasound findings. Cases were sub-divided according to mode of delivery, and mean umbilical venous flow rates compared between the groups. Cases were also sub-divided according to umbilical venous flow rate (<20th centile, 20th-80th centile, >80th centile) and the incidence of diagnoses of fetal compromise compared.
RESULTS: Fetuses delivered by emergency cesarean for presumed fetal compromise had the lowest umbilical venous flow rates (both corrected for and uncorrected for birth weight) (p=0.02 and 0.001 respectively). Fetuses with the lowest umbilical venous flow rates were significantly more likely to require emergency cesarean for presumed fetal compromise than those with the highest flow rates (15.7% vs. 5.6%, relative risk 2.83, 95% CI 1.16-6.91).
CONCLUSIONS: Fetuses with the lowest umbilical venous flow rates are at increased risk of a subsequent diagnosis of intra-partum fetal compromise. Measurement of umbilical venous flow could contribute to the risk stratification of pregnancies prior to labour.
Authors:
Tomas Prior; Edward Mullins; Phillip Bennett; Sailesh Kumar
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-30
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-9-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Affiliation:
Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK.
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