Doppler Findings in Intrapartum Fetal Distress

Abstract

The umbilical vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CGT) and 26 fetuses with abnormal CTGs (GA>37w and cervical dilatation>3cm). Perinatal outcome was assessed according to presence or absence of UV pulsations. The 2 groups were similar regarding gestational age, cervical dilatation, Umbilical artery blood pH, S/D ratio,Pulsatility Index( PI) and Resistance Index (RI). Intraabdominal UV pulsation were present in 6 (23.1%) of abnormal CTG group but no case were seen in normal CTG group (P= 0.005). Five of 6 (83.3%) fetuses with UV pulsation underwent cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score <7 was more in fetuses with UV pulsations (16.7% vs 5%) although not statistically significant. NICU admission was considerably more in UV pulsation group (33% vs 5%, P= 0.123). After exclusion of LBW fetuses the UV pulsation was present in 4 (19%) of abnormal CTG group, who 3 of them underwent cesarean section. Neither umbilical artery pH<7 nor Apger score <7 or NICU admission were seen in these 4 neonates. Pulsation in UV was seen in 23% of fetuses with abnormal CTG during intra partum period. Cesarean delivery and NICU admission was increased in fetuses with UV pulsations, although not statistically significant. When LBW fetuses were excluded no case of UA pH<7, Apgar sore <7or NICU admission were seen.