Meconium and birth asphyxia
Volume 165 Number 4, Part 1
plicated term vaginal deliveries. AM ] OBSTET GVNECOL 1985; 151 :798-80 1. 18. Thorp ]A, Sampson ]E, Parisi VM, Creasy RK. Routine umbilical cord gas determinations. AM] OBSTET GVNECOL 1989;161:600-5. 19. Gilstrap LC, Leveno K], Burris], Williams ML, Little BB. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. AM] OBSTET GVNECOL 1989; 161 :825-30.
20. Freeman ]M, Nelson KB. Intrapartum asphyxia and cerebral palsy. Pediatrics 1988;82:240-4. 21. Weitzner ]S, Strassner HT, Rawlins RG, et al. Objective assessment of meconium content of amniotic fluid. Obstet Gynecol 1990;76: 1143-4. 22. Yeomans ER, Gilstrap LC, Leveno K], Burris ]S. Meconium in the amniotic fluid and fetal acid-base status. Obstet Gynecol 1989;73: 175-8.
The relationship between umbilical artery Doppler velocimetry and fetal biometry William E. Scorza, MD, Deborah Nardi, RT(R), RDMS, Anthony M. Vintzileos, MD, Alfred D. Fleming, MD, John F. Rodis, MD, and Winston A. Campbell, MD Farmington, Connecticut The relationship between peak-systolic/ end-diastolic ratio of the umbilical artery waveform and fetal biometry was studied in 127 uncomplicated pregnancies with established dates between 20 and 40 weeks' gestation. At each ultrasonographic examination fetal biometry included measurement of the biparietal diameter, head circumference, abdominal circumference, and femur length. The peak-systolic/end-diastolic ratio was measured by either a continuous or a pulsed-wave method. There were significant linear negative correlations between all the biometric parameters, as well as between the ultrasonographically estimated fetal weight and peak-systolic/end-diastolic ratio. Of the individual ultrasonographic parameters the femur length (for gestations -
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Fig. 2. Scattergram illustrating relationship (along with 10th, 50th, and 90th percentile lines) between umbilical artery peak-systolic I end-diastolic (SID) ratio and head circumference (r = 0.422, P = 0.0001).
different sampling sites were computed, and the mean ratio was used in the analysis. Scattergrams of the peak-systolic! end-diastolic ratio values versus gestational age and fetal biometry were developed. Regression analyses were used to establish nomograms, including the 10th, 50th, and 90th percentile lines. To assess which fetal biometric para meteres), if any, best correlated with the peak-systolic/ enddiastolic ratio, multiple regression analyses and stepwise regression analyses were used. A p value < 0.05 was considered statistically significant. The statistical analysis of the data was performed by computer (Macintosh II) with the Stat View 512 + (Abacus Concepts, Berkeley, Calif.) and CricketGraph (CricketGraph, Malvern, Pa.) statistical packages. During the study period there were 25 patients with known dates (based on last menstrual period and confirmed by early ultrasonography) who had growthretarded fetuses (estimated fetal weights < - 2 SD from the mean for gestational age).s The gestational ages of these fetuses ranged from 26 to 38 weeks. The fetuses were used to determine the sensitivity of the newly constructed nomograms on the basis of fetal biometry, to predict growth retardation. In all 25 fetuses the diagnosis of IVGR was confirmed after birth.
Results The study population consisted of 127 patients with gestational age (mean ± SD) of 31 ± 4 weeks (median,
31.1). Of these , 104 (81 %) were white, 12 (10%) black, and 11 (9%) Hispanic. Seventy patients (55 %) were nulliparous and 57 (45%) were multiparous. The maternal age (mean ± SD) was 26.3 ± 5.6 years (range, 15 to 40). The best-fit curves between peak-systolic/ enddiastolic ratio and biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight were linear. The r values were 0.395 , 0.422,0.461,0.453, and 0.460, respectively (all p values were = 0.0001). The scattergrams, including the 10th, 50th, and 90th percentile boundaries, and the regression equations are illustrated in Figs. 1 to 5 . The estimated fetal weight had the highest linear negative correlation with the peak-systolic/ end-diastolic ratio (r = 0.461). The best-fit curve between the peaksystolic/ end-diastolic ratio and gestational age also was linear (Fig. 6). To determine the origins and to assess which fetal biometric parameters contribute to this negative correlation between estimated fetal weight and the peaksystolic/ end-diastolic ratio, the data were analyzed according to two gestational age groups, ...
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each gestational age group. multiple regression analyses and stepwise regression analyses were used with the peak-systolic lend-diastolic ratio used as the dependent (outcome) variable and biparietal diameter, head
circumference, abdominal circumference, and femur length used as the inde pendent (predictors) variables. Multiple regression analysis o f he t group < 30 weeks' gestation revealed that the overall association was sig-
Umbilical artery velocimetry and fetal biometry
Volume 165 Number 4, Part I
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nificant (p < 0.05). Of th~ four independent variables, only femur length was significantly correlated with the peak-systolic! end-diastolic ratio (p < 0.05; 13 coefficient, -0.477; standard error, 0.211; standard coeffi-
cient, - 0.673; t value, 2.262). Stepwise regression analysis of this group of fetuses of
Volume 165 Number 4, Part 1
plicated term vaginal deliveries. AM ] OBSTET GVNECOL 1985; 151 :798-80 1. 18. Thorp ]A, Sampson ]E, Parisi VM, Creasy RK. Routine umbilical cord gas determinations. AM] OBSTET GVNECOL 1989;161:600-5. 19. Gilstrap LC, Leveno K], Burris], Williams ML, Little BB. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. AM] OBSTET GVNECOL 1989; 161 :825-30.
20. Freeman ]M, Nelson KB. Intrapartum asphyxia and cerebral palsy. Pediatrics 1988;82:240-4. 21. Weitzner ]S, Strassner HT, Rawlins RG, et al. Objective assessment of meconium content of amniotic fluid. Obstet Gynecol 1990;76: 1143-4. 22. Yeomans ER, Gilstrap LC, Leveno K], Burris ]S. Meconium in the amniotic fluid and fetal acid-base status. Obstet Gynecol 1989;73: 175-8.
The relationship between umbilical artery Doppler velocimetry and fetal biometry William E. Scorza, MD, Deborah Nardi, RT(R), RDMS, Anthony M. Vintzileos, MD, Alfred D. Fleming, MD, John F. Rodis, MD, and Winston A. Campbell, MD Farmington, Connecticut The relationship between peak-systolic/ end-diastolic ratio of the umbilical artery waveform and fetal biometry was studied in 127 uncomplicated pregnancies with established dates between 20 and 40 weeks' gestation. At each ultrasonographic examination fetal biometry included measurement of the biparietal diameter, head circumference, abdominal circumference, and femur length. The peak-systolic/end-diastolic ratio was measured by either a continuous or a pulsed-wave method. There were significant linear negative correlations between all the biometric parameters, as well as between the ultrasonographically estimated fetal weight and peak-systolic/end-diastolic ratio. Of the individual ultrasonographic parameters the femur length (for gestations -
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Fig. 2. Scattergram illustrating relationship (along with 10th, 50th, and 90th percentile lines) between umbilical artery peak-systolic I end-diastolic (SID) ratio and head circumference (r = 0.422, P = 0.0001).
different sampling sites were computed, and the mean ratio was used in the analysis. Scattergrams of the peak-systolic! end-diastolic ratio values versus gestational age and fetal biometry were developed. Regression analyses were used to establish nomograms, including the 10th, 50th, and 90th percentile lines. To assess which fetal biometric para meteres), if any, best correlated with the peak-systolic/ enddiastolic ratio, multiple regression analyses and stepwise regression analyses were used. A p value < 0.05 was considered statistically significant. The statistical analysis of the data was performed by computer (Macintosh II) with the Stat View 512 + (Abacus Concepts, Berkeley, Calif.) and CricketGraph (CricketGraph, Malvern, Pa.) statistical packages. During the study period there were 25 patients with known dates (based on last menstrual period and confirmed by early ultrasonography) who had growthretarded fetuses (estimated fetal weights < - 2 SD from the mean for gestational age).s The gestational ages of these fetuses ranged from 26 to 38 weeks. The fetuses were used to determine the sensitivity of the newly constructed nomograms on the basis of fetal biometry, to predict growth retardation. In all 25 fetuses the diagnosis of IVGR was confirmed after birth.
Results The study population consisted of 127 patients with gestational age (mean ± SD) of 31 ± 4 weeks (median,
31.1). Of these , 104 (81 %) were white, 12 (10%) black, and 11 (9%) Hispanic. Seventy patients (55 %) were nulliparous and 57 (45%) were multiparous. The maternal age (mean ± SD) was 26.3 ± 5.6 years (range, 15 to 40). The best-fit curves between peak-systolic/ enddiastolic ratio and biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight were linear. The r values were 0.395 , 0.422,0.461,0.453, and 0.460, respectively (all p values were = 0.0001). The scattergrams, including the 10th, 50th, and 90th percentile boundaries, and the regression equations are illustrated in Figs. 1 to 5 . The estimated fetal weight had the highest linear negative correlation with the peak-systolic/ end-diastolic ratio (r = 0.461). The best-fit curve between the peaksystolic/ end-diastolic ratio and gestational age also was linear (Fig. 6). To determine the origins and to assess which fetal biometric parameters contribute to this negative correlation between estimated fetal weight and the peaksystolic/ end-diastolic ratio, the data were analyzed according to two gestational age groups, ...
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each gestational age group. multiple regression analyses and stepwise regression analyses were used with the peak-systolic lend-diastolic ratio used as the dependent (outcome) variable and biparietal diameter, head
circumference, abdominal circumference, and femur length used as the inde pendent (predictors) variables. Multiple regression analysis o f he t group < 30 weeks' gestation revealed that the overall association was sig-
Umbilical artery velocimetry and fetal biometry
Volume 165 Number 4, Part I
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nificant (p < 0.05). Of th~ four independent variables, only femur length was significantly correlated with the peak-systolic! end-diastolic ratio (p < 0.05; 13 coefficient, -0.477; standard error, 0.211; standard coeffi-
cient, - 0.673; t value, 2.262). Stepwise regression analysis of this group of fetuses of
