Dr. Vicente Serra of the University of Valencia and colleagues note that there is no uniform consensus for the correct timing of the delivery of such fetuses and several monitoring approaches are used. Among these is STV analyzed via computerized cardiotocography.
To examine the utility of the method, the researchers retrospectively studied data on 257 fetuses with birthweight below the third percentile for gestational age. All had had cardiotocography performed within 24 hours of delivery.
The team found that decreasing STV was significantly correlated with earlier deliveries, lower birthweight, lower umbilical artery pH at birth, worse acid-base status at birth and worse postnatal outcome.
"The STV was able to predict the presence or absence of acidemia and metabolic acidemia," the investigators report. The optimum cutoff of 3 milliseconds or less yielded a positive predictive value of 64.6% and a negative predictive value of 86.9%.
There were no stillbirths or neonatal deaths within the first 24 hours. However, an STV of 3.0 milliseconds or less was associated with markedly higher rate of metabolic acidemia (54.2%) and early neonatal death (8.3%). Corresponding rates for STVs greater than 3 milliseconds were 10.5% and 0.5%.
The monitoring system, say the researchers, "avoided stillbirths and neonatal deaths within 24 hours of delivery in our series and predicted objectively the acid-base status at birth in a significant proportion of growth-retarded fetuses."
However, they also point out that timing of delivery remains difficult and as "each monitoring test provides complementary information, the STV is likely to perform best when used in combination with other methods."
BJOG 2008;115:1101-1107. [标签:content1][标签:content2]
作者:admin@医学,生命科学 2011-02-15 17:14