Prediction of acidemia at birth by Doppler assessment of fetal cerebral transverse sinus in pregnancies with placental insufficiency

• Autor(a) principal: Barbosa, Maurício Mendes [UNIFESP]
• Data de Publicação: 2009
• Outros Autores: Carvalho, Francisco Herlânio Costa [UNIFESP], Araujo Junior, Edward [UNIFESP], Nardozza, Luciano Marcondes Machado [UNIFESP], Santana, Renato Martins [UNIFESP], Torloni, Maria Regina [UNIFESP], Moron, Antonio Fernandes [UNIFESP]
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1002/uog.6130; http://repositorio.unifesp.br/handle/11600/31258
• topic: acidemia; birth; Doppler; placental insufficiency; ultrasound

Objectives To evaluate the prediction of acidemia at birth using cerebral transverse sinus (CTS) Doppler velocimetry and to determine the best parameter and cut-off values for its prediction in pregnancies complicated with placental insufficiency.Methods This was a prospective cross-sectional study involving 69 pregnant women (26-40 weeks' gestation) with placental insufficiency managed in two Brazilian hospitals. Doppler assessment of the CTS was carried out in the last 24 h before delivery, and the peak ventricular systolic (S-wave) and diastolic (D-wave) velocities as well as the atrial systolic velocity (A-wave) were recorded and the pulsatility index for veins (PIV) was calculated. At birth, arterial and venous umbilical cord blood samples were collected to determine acid-base and pH status. A receiver-operating characteristics (ROC) curve was constructed for each Doppler parameter with birth acidemia as the dependent variable. Sensitivity, specificity, positive and negative predictive values, accuracy and false-positive and false-negative rates were calculated for the parameters considered to be good predictors of acidemia.Results the S, D and A peak velocities and the S/A ratio were not good predictors of acidemia at birth. the PIV and the (S - A)/S ratio were good predictors of acidemia (area under the ROC curve = 0.698 (P = 0.009) and 0.654 (P = 0.009), respectively). the cut-off values were PIV = 0.855 and (S - A)/S = 0.703).Conclusions the PIV and the (S - A)/S ratio of the CTS were good predictors of acidemia at birth in this high-risk population with placental insufficiency. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.