Vibratory acoustic stimulation in 26- to 32-week, small-for-gestational-age fetus

Seven pregnant women with early-onset (less than 32 weeks' gestation) intrauterine growth retardation were studied to examine fetal heart rate and fetal activity patterns after vibratory acoustic stimulation. All studies were done between 26 and 32 weeks' gestation. All fetuses but one were not acidotic at birth. There was a reduced time during which accelerations (50% less), long-term fetal heart rate variability (25% less), and body movements (60% less) occurred in small-for-gestational-age fetuses compared with these times in age-matched normally grown fetuses. Fetal heart rate and fetal activity patterns were not significantly altered after stimulation with the electronic artificial larynx. We hypothesized that severe, early-onset (less than 32 weeks' gestation), chronic nutritional deprivation of human fetuses is associated with a delay in the functional maturation of fetal sensory receptors.     

Comparison of late-second-trimester nonstress test characteristics between small for gestational age and appropriate for gestational age infants

OBJECTIVE: To compare electronic fetal heart rate (FHR) monitoring characteristics between appropriate for gestational age (AGA) fetuses and small for gestational age (SGA) fetuses and to determine whether SGA fetuses have specific abnormalities at second-trimester electronic fetal monitoring (EFM), using nonstress test. METHODS: Among 953 children born from 1993-1996, we identified 500 singleton infants born after 36 weeks' gestation of uncomplicated pregnancies in whom second-trimester (24-27 weeks' gestation) EFM records were obtained. Individual components of FHR patterns (baseline rate, baseline FHR variability, presence of acceleration [at least 10 beats per minute for at least 10 seconds], and periodic or episodic deceleration [at least 25 beats per minute for at least 15 seconds]) and birth characteristics were compared between AGA and SGA infants, or between pregnancies with or without second-trimester decelerations. RESULTS: Among 500 infants, 443 were AGA and 57 SGA; 105 had and 395 did not have second-trimester decelerations. Baseline FHR variability (12.9+/-3.2 beats per minute) in SGA fetuses was significantly higher than variability (10.3+/-3.4 beats per minute) in AGA fetuses (P<.001). Small for gestational age fetuses were significantly more likely to have second-trimester decelerations than AGA fetuses (33.3% vs. 19.4%, P<.05). There were no significant differences in baseline rate and accelerations between AGA and SGA infants. Small for gestational age infants were more frequent in pregnancies with second-trimester decelerations, compared with those without second-trimester decelerations (18.1% vs. 9.6%, P<.05). Baseline FHR variability in pregnancies with second-trimester decelerations was significantly higher than in pregnancies without second-trimester decelerations (12.2+/-3.7 vs. 10.0+/-3.1 beats per minute, P<.001). CONCLUSION: Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were associated with an increased risk of SGA birth weight.     

Fetal heart rate patterns in the small-for-gestational-age human fetus

A total of 24 pregnant women with growth-retarded fetuses were studied to examine the distribution of fetal heart rate accelerations between 30 and 40 weeks' gestation, as compared with those of fetuses of normal growth that were matched for gestational age and length of fetal heart rate tracings. Growth-retarded fetuses had significantly lower PO2 levels in the umbilical artery at birth (3 mm Hg less) than did healthy fetuses (p less than 0.05), but without metabolic acidosis. There was a larger proportion of small amplitude (less than 10 beats/min) and a smaller proportion of large amplitude (greater than 20 beats/min) fetal heart rate accelerations in the small-for-gestational-age fetuses than in the fetuses of normal growth. Although the number of accelerations was significantly reduced (50% less) in growth-retarded fetuses compared with healthy fetuses, there was no significant difference in the mean basal fetal heart rate and the mean number of decelerations between the two groups. Currently used definition of an acceleration as greater than or equal to 15 beats/min for greater than or equal to 15 seconds was applicable only in fetuses of normal growth. We hypothesized that a decrease in absolute acceleration frequency might be a useful index to detect the chronically hypoxemic fetus before severe metabolic acidosis and irreversible damage occurred.     

Fetal acoustic stimulation in the early intrapartum period as a predictor of subsequent fetal condition

Fetal acoustic stimulation has recently received much attention in the literature. This study evaluates fetal acoustic stimulation in the early intrapartum period as a predictor of subsequent fetal condition. The study group consisted of 201 patients, approximately 60% of whom had complicated pregnancies. All were in the latent phase of labor with singleton, vertex-presenting fetuses. Gestational age ranged from 37 to 43 weeks. Fourteen of the 201 fetuses (7%) showed a nonreactive response to fetal acoustic stimulation and those fetuses were at significantly greater risk of initial and subsequent abnormal fetal heart rate patterns, meconium staining, and cesarean delivery because of fetal distress and Apgar scores less than 7 at both 1 and 5 minutes. Transient fetal heart rate decelerations after a reactive response occurred in 25% of patients; however, fetal outcome was not worse in this group. A reactive response to fetal acoustic stimulation was associated with high specificity and negative predictive values. Therefore we conclude that fetal acoustic stimulation in the early intraprtum period may discriminate the compromised from the noncompromised fetus.     

Identification of the small for gestational age fetus with the use of gestational age-independent indices of fetal growth

This study reviews the roles of sonographic assessment of the rate of growth of the fetal abdominal circumference, the femur length/abdominal circumference ratio, and qualitative determination of amniotic fluid volume as gestational age-independent indices for identification of the small for gestational age fetus. The sensitivity and specificity for single and combinations of test results were evaluated in 50 appropriate for gestational age and 40 small for gestational age fetuses. Positive and negative predictive values were derived for the general population. Our results indicate that either a rate of growth of the fetal abdominal circumference less than or equal to 10 mm/14 days or a femur length/abdominal circumference ratio greater than or equal to 23.5 correctly identifies most small for gestational age fetuses. When the general population is screened, only 15% of small for gestational age fetuses will be missed by this combination of criteria. The presence of a pocket of amniotic fluid less than or equal to 2.0 cm is highly suggestive of a small for gestational age fetus. However, the presence of a pocket of amniotic fluid greater than 2.0 cm does not guarantee an appropriate for gestational age fetus. We conclude that these gestational age-independent indices of fetal growth offer useful tools for differentiating between the small for gestational age and appropriate for gestational age fetus.     

Fetal heart rate monitoring and neonatal mortality in the very preterm infant

A retrospective study was performed to determine the usefulness of intrapartum fetal heart rate patterns in managing infants of 26 to 30 weeks' gestational age by a comparison of intrapartum tracings with neonatal outcome. Fetal heart rate patterns of 26 infants who died were matched for gestational age with those of infants who did not die or demonstrate developmental abnormalities after a 1-year follow-up were analyzed. A normal fetal heart rate pattern was associated with a good outcome (p less than 0.05), the only deaths (three) being secondary to unrelated factors. An abnormal fetal heart rate tracing predicted 90% of deaths; however, an abnormal fetal heart rate tracing was also found in 15 of 31 infants with no mortality or morbidity. Evidence would thus suggest that the very preterm infant can tolerate the stress associated with normal labor and that a normal fetal heart rate pattern predicts good fetal outcome in the absence of unrelated perinatal abnormality. With significantly abnormal patterns, however, further parameters must be evaluated before the diagnosis of fetal distress associated with subsequent mortality can be made with certainty.     

Intrapartum fetal heart rate monitoring in cases of cytomegalovirus infection

OBJECTIVE: Several studies have shown that abnormal intrapartum fetal heart rate patterns are the results from pre-existing fetal brain damage. We evaluated intrapartum fetal heart rate pattern of cytomegalovirus-infected fetuses and correlated the patterns with neurologic outcomes. STUDY DESIGN: Between 1991 and 2001, there were 20 cytomegalovirus-infected fetuses. We selected 40 fetuses as control subjects that were matched for gestational age and birth weight. Fetal heart rate was interpreted according to the guidelines of the National Institute for Child and Human Development. The incidence of abnormal fetal heart rate pattern and umbilical blood gases were compared between both groups. We also investigated the factors that contributed to abnormal fetal heart rate pattern in the cytomegalovirus group. RESULTS: Nonreassuring fetal heart rate patterns (prolonged deceleration and recurrent late deceleration) were observed in 8 of 20 fetuses (prolonged deceleration, 7 fetuses; recurrent late deceleration, 1 fetus) in the cytomegalovirus group and in 3 of 41 fetuses (prolonged deceleration, 1 fetus; recurrent late deceleration, 2 fetuses) in the control group (P<.05, Fisher test). Baseline fetal heart rate variability was minimal in 4 of the 7 prolonged deceleration cases in the cytomegalovirus group. Umbilical pH <7.1 was found for 1 fetus in the cytomegalovirus group. The average umbilical arterial pH values were similar in both the groups. In the cytomegalovirus group, there were no differences in the incidence of contributing factors between 8 fetuses with abnormal fetal heart rate pattern (prolonged deceleration and recurrent late deceleration) and 8 fetuses with no change. There were 3 fetuses with cerebral palsy: 2 fetuses in the no change group and 1 fetus in the prolonged deceleration group. Antigenemia was positive exclusively in 4 cases with abnormal fetal heart rate pattern (P<.05). CONCLUSION: Cytomegalovirus-infected fetuses are more likely to show abnormal intrapartum fetal heart rate patterns than low-risk control fetuses, which suggests that the perinatal detection of cytomegalovirus is necessary to distinguish hypoxic-ischemic encephalopathy.     

Sonographically estimated fetal weight percentile as a predictor of preterm delivery

OBJECTIVE: To evaluate the association between relative growth restriction and preterm birth. STUDY METHODS: Pregnant women referred for sonographic fetal weight assessments between 24 and 34 weeks of gestation were studied for gestational age at delivery. If a patient underwent more than one study, only the last one was considered. Patients with delivery induced iatrogenically or with abnormal growth patterns due to known pathology, such as maternal diabetes or fetal congenital anomaly, were excluded. A gestational age of 37 weeks or less was considered preterm and a gestational age of more than 37 weeks at delivery was considered term. Fetal weight estimation was obtained by Hadlock's formula based on biparietal diameter, femur length, and head and abdominal circumferences. The estimated fetal weight percentile was computed according to William's tables. Mean gestational age and incidence of preterm delivery for each fetal weight percentile between 1 and 100, at increments of 10, were calculated. The mean estimated fetal weight percentile, biparietal diameter, femur length, head circumferences and abdominal circumferences of preterm and term patients were compared. RESULTS: Among the 419 patients who met the inclusion criteria, duration of gestation was significantly shorter in fetuses with low estimated fetal weight percentile. The risk of preterm birth was 49% in fetuses of less than the 40th birth-weight percentile compared with a risk of 20% in fetuses of more than the 40th birth-weight percentile, representing a relative risk of 2.3. Individual fetal measurements indicate a head-sparing effect in the preterm group. CONCLUSION: Sonographically estimated fetal weight percentile measured between 24 and 34 weeks' gestation may be used as an additional and individually pertinent predictor of preterm birth.     

Sonographically estimated fetal weight percentile as a predictor of preterm delivery

Objective : To evaluate the association between relative growth restriction and preterm birth. Study methods : Pregnant women referred for sonographic fetal weight assessments between 24 and 34 weeks of gestation were studied for gestational age at delivery. If a patient underwent more than one study, only the last one was considered. Patients with delivery induced iatrogenically or with abnormal growth patterns due to known pathology, such as maternal diabetes or fetal congenital anomaly, were excluded. A gestational age of 37 weeks or less was considered preterm and a gestational age of more than 37 weeks at delivery was considered term. Fetal weight estimation was obtained by Hadlock's formula based on biparietal diameter, femur length, and head and abdominal circumferences. The estimated fetal weight percentile was computed according to William's tables. Mean gestational age and incidence of preterm delivery for each fetal weight percentile between 1 and 100, at increments of 10, were calculated. The mean estimated fetal weight percentile, biparietal diameter, femur length, head circumferences and abdominal circumferences of preterm and term patients were compared. Results : Among the 419 patients who met the inclusion criteria, duration of gestation was significantly shorter in fetuses with low estimated fetal weight percentile. The risk of preterm birth was 49% in fetuses of less than the 40th birth-weight percentile compared with a risk of 20% in fetuses of more than the 40th birth-weight percentile, representing a relative risk of 2.3. Individual fetal measurements indicate a head-sparing effect in the preterm group. Conclusion : Sonographically estimated fetal weight percentile measured between 24 and 34 weeks' gestation may be used as an additional and individually pertinent predictor of preterm birth.     

Preterm and term fetal cardiac and movement responses to vibratory acoustic stimulation

To assess fetal response to vibratory acoustic stimulation, 24 preterm (group A; less than 36 weeks' gestation) and 30 term (group B; greater than or equal to 36 weeks' gestation) pregnancies were studied. Study variables were perceived fetal movement, fetal heart rate, and fetal heart rate pattern. Observer- and patient-perceived fetal movement responses were noted in most cases but were slightly more common in term patients (group A: + fetal movement, patient 87.5%/observer 87.5%) group B: + fetal movement, patient 96.7%/observer 90%). Baseline changes in fetal heart rate (greater than or equal to 10 beats/min) were observed in 46% of preterm fetuses and 70% of term fetuses. Tachycardia (fetal heart rate greater than 160 beats/min) was a common finding in both groups. In group A, tachycardia after vibratory acoustic stimulation persisted more than 1 minute in 29.2% and more than 5 minutes in 12.5% of patients. In group B tachycardia beyond 1 and 5 minutes was noted in 73.3% and 50% of patients, respectively. A significant shift to "awake" fetal heart rate patterns occurred in both groups; 29% to 79% was noted in group A (p less than 0.001) and 46.7% to 90% in group B (p less than 0.001). When vibratory acoustic stimulation was used, the high occurrence of increased baseline, tachycardia, and emergence of unusual fetal heart rate patterns must be recognized to adequately interpret fetal heart rate tracings.     

The relationship between fetal activity and behavioral states and fetal breathing movements in normal and growth-retarded fetuses

The incidence of fetal breathing was studied during the course of behavioral state observations on 28 low-risk fetuses between 32 and 40 weeks' gestational age and on 12 growth-retarded fetuses between 36 and 40 weeks. Real-time ultrasound scanners were used to detect fetal eye, body, and breathing movements, and the fetal heart rate was recorded continuously. The mean duration of the observation sessions was 110 minutes. The mean incidence of fetal breathing was greater during periods of fetal activity (body and eye movements present, greater heart rate variability) than during quiescence (body and eye movements absent, narrowed heart rate variability) at all gestational ages studied in both low-risk and growth-retarded fetuses. During periods when one of the state variables (body movements, eye movements, heart rate pattern) was in its active condition while the other two were quiet, or the reverse, the incidence of fetal breathing was intermediate between those found when all three state variables were in agreement. After behavioral states had developed, at 38 and 40 weeks, the mean incidence of fetal breathing in the low-risk fetuses was greater during active states than during the quiet state. There was no apparent increase in the degree of linkage between fetal breathing and other expressions of fetal activity after the emergence of behavioral states.     

Characterization of the reduced heart rate variation in growth-retarded fetuses

Summary. Fetal heart rate (FHR) variation has been studied by computerized numerical analysis in 20 growth-retarded fetuses and 20 normal fetuses matched for gestational age. FHR variation was significantly reduced in the 14 growth-retarded fetuses where there was clinical evidence of associated pathology. Rest - activity cycles were assessed by changes in FHR variation and fetal movements. The growth-retarded fetuses with reduced FHR variation showed the same pattern of rest and activity as normal fetuses but the changes in FHR variation were of lower amplitude. This was observed even in the subgroup of six fetuses with the lowest FHR variation. Thus the unreactive FHR patterns associated with growth retardation do not arise because the fetus spends less time in activity.     

Umbilical artery Doppler velocimetry as a labor admission test

Doppler ultrasound of the umbilical artery flow velocity waveform was studied prospectively as an admission test at the labor ward. Recordings were made in 575 women in various stages of labor before, during, and after uterine contractions, and evaluated in relation to intrapartum and fetal outcome variables. No association was found between abnormal flow velocity waveforms and cord complications, meconium-stained amniotic fluid, or abnormal fetal heart rate tracing, nor was there any association with operative delivery for fetal distress or low Apgar scores at 1 and 5 minutes. Small for gestational age fetuses had significantly more abnormal flow velocity waveforms than appropriate for gestational age fetuses, and so had those with umbilical artery acidemia compared with those with normal pH. The results indicate that Doppler recording of the umbilical artery flow velocity waveform as an admission test at the labor ward is not a good predictor of fetal distress in an unselected population.     

Physiologic baroreceptor activity in the fetal lamb.

OBJECTIVE: We investigated the influences of gestational age and behavioral state on fetal baroreceptor activity. STUDY DESIGN: Two protocols were used to analyze low-voltage fast activity and high-voltage slow activity in eight chronically instrumented ovine fetuses at days 127 to 142. In protocol 1 correction of fetal heart rate to mean arterial blood pressure was assessed under physiologic conditions, and the linear regression slope of fetal heart rate on mean arterial pressure was calculated. In protocol 2 an injection of 7.5 micrograms of norepinephrine was given during consecutive behavioral cycles. The ratio of fetal heart rate decrease to mean arterial pressure increase was determined as representing baroreceptor activity. RESULTS: Under protocol 1 the slope was steeper in high-voltage slow activity (2.33 +/- 1.03) than in low-voltage fast activity (0.89 +/- 0.37) (n = 21, p less than 0.001), indicating that fetal heart rate changes are sensitive to blood pressure changes during high-voltage slow activity. Under protocol 2 inverse relationships were found between the ratio of fetal heart rate decrease to mean arterial pressure increase and gestational age in low-voltage fast activity and high-voltage slow activity. CONCLUSION: Fetal baroreceptor activity increased during high-voltage slow activity and decreased with gestational age.     

Sonographic evaluation of fetal abdominal growth: predictor of the large-for-gestational-age infant in pregnancies complicated by diabetes mellitus

Serial ultrasound examinations were performed during the third trimester in 79 pregnant women with diabetes to establish the onset of accelerated fetal growth. At least three ultrasound examinations were performed, with a minimum scan interval of 2 weeks. Growth curves constructed for femur length and head circumference were similar for fetuses appropriate for gestational age (n = 48) and fetuses large for gestational age (n = 31). The mean changes in femur length and head circumference (expressed as centimeters per week during the early and late third trimesters) did not differ statistically between these two groups. Abdominal circumference growth was clearly accelerated at 32 weeks' gestation in the large for gestational age group (mean +/- SD, 1.36 +/- 0.16 cm/wk) compared with the appropriate for gestational age group (0.901 +/- 0.21 cm/wk, p less than 0.001). With use of a receiver operator characteristic curve, a change in abdominal circumference of 1.2 cm/wk over the period of 32 to 39 weeks' gestation was determined to be an optimal cutoff for detecting excessive fetal growth (sensitivity 84%, specificity 85%). A change in abdominal circumference 1.2 cm/wk was present in 4/4 large-for-gestational age fetuses (less than 4000 gm), in 17/21 (81%) of fetuses with birth weights 4000 to 4499 gm, and in 5/6 (83%) whose weight exceeded 4500 gm. It appears that improved detection of the fetus large for gestational age in diabetic pregnancies may be accomplished by the use of serial ultrasonography during the third trimester.     

Relationship between cyclic variation of fetal heart rate patterns and cord pH in preterm gestations

The presence or absence of cyclic variation (cyclicity) of fetal heart rate patterns was prospectively investigated in fetuses between 25 and 32 weeks' gestation. All fetuses were delivered by cesarean section before the onset of labor. The relationship between the presence or absence of fetal heart rate cyclicity and fetal acidosis, as determined by cord pH measurements, was investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of this method in predicting fetal acidosis were: 100, 90, 50, and 100%, respectively. All fetuses with reactive nonstress tests also had fetal heart rate cyclicity present and none were acidotic at birth. The majority of fetuses (68.8%) with nonreactive nonstress tests had fetal heart rate cyclicity present and none were acidotic; fetuses with nonreactive nonstress tests and absence of fetal heart rate cyclicity were acidotic in 50% of the cases. These preliminary data suggest that the presence or absence of fetal heart rate cyclicity may help to select the healthy preterm fetuses with nonreactive nonstress testing who are in good condition and therefore in no need for further testing.     

The effect of antenatal steroid administration on the fetal response to vibroacoustic stimulation

BACKGROUND: Betamethasone transiently suppresses multiple fetal biophysical activities, including breathing movements, limb and trunk movements, heart rate variability, and heart rate accelerations. Unnecessary iatrogenic delivery of preterm fetuses due to the false diagnosis of fetal compromise has been described in this setting. The sonographically observed startle response of the fetus to vibroacoustic stimulation has been described as another modality to provide reassurance about fetal well-being. It is unknown, however, whether the startle response is also suppressed by betamethasone. The purpose of this study was to examine the effect of betamethasone on this biophysical parameter. METHODS: A prospective cohort study. Vibroacoustic stimulation was applied to the maternal abdomen and fetal movement responses were sonographically observed prior to (0 hours), 48 hours after, and 96 hours after betamethasone administration. We recorded the presence or absence of the fetal startle response, and, if a response was present, graded semi-quantitatively the intensity of the movements (vigorous versus sluggish). RESULTS: Twenty-two of 26 fetuses (84.6%) displayed a vigorous vibroacoustic startle response prior to betamethasone administration, in comparison to three of 26 fetuses (11.5%) at 48 hours after exposure (p<0.0001). Eleven fetuses and eight fetuses displayed no startle response at all (p<0.0005), or a sluggish response only (p<0.0005) at 48 hours, respectively. At 96 hours after betamethasone exposure, no differences in the number of fetuses with a vigorous, sluggish, or absent response were observed in comparison to 0 hours. Stratification of cases by gestational age groups of 28-30 weeks versus 31-34 weeks showed similar response patterns. CONCLUSION: Antenatal betamethasone exposure transiently suppresses the sonographically observed fetal startle response to vibroacoustic stimulation. Accordingly, this modality cannot be used for the ascertainment of fetal well-being of steroid exposed fetuses. Betamethasone seems to suppress central nervous system dependent biophysical activities. including the brain-stem dependent vibroacoustic startle reflex.     

A comparison of single versus multiple growth ultrasonographic examinations in predicting birth weight

OBJECTIVE: Our purpose was to determine whether two or more ultrasonographic fetal growth assessments provide a superior estimate of birth weight than does a single examination. STUDY DESIGN: Five hundred and eighty five ultrasonographic procedures were performed in 263 patients, divided into single (n = 249) and multiple (n = 247) examination groups. Ultrasonographically estimated fetal weight percentiles and abdominal circumference percentiles were compared with gestationally corrected birth weight percentiles. After the gestational age range with the fewest errors in birth weight percentile prediction (32 to 36 weeks) was determined, patients with a single examination in this range were assigned to the single examination group. In the group with multiple examinations averaged ultrasonographic percentiles were used to predict birth weight percentile. Mean absolute and percentage errors were compared for predictive accuracy by means of analysis of variance and Student t test. RESULTS: There was a linear correlation between the estimated fetal weight and abdominal circumference percentiles and the birth weight percentile, (r = 0.72, p < 0.0001). The accuracy of birth weight percentile predictions was similar whether one or multiple examinations were performed in the third trimester. Both the abdominal circumference percentile and estimated fetal weight percentile underpredicted birth weight, although the abdominal circumference percentile errors (1% to 2%) were statistically smaller than those derived from estimated fetal weights percentile (9% to 11%, p < 0.0001). Both abdominal circumference percentile and estimated fetal weights percentile consistently overidentified fetuses <10th percentile (small for gestational age) and underidentified fetuses >90th percentile (large for gestational age). However, multiple abdominal circumference percentile measurements resulted in improved predictions for small for gestational age (sensitivity 100%, specificity 88%) and large for gestational age (sensitivity 84%, specificity 100%). CONCLUSIONS: With either the single or multiple examination approach birth weight percentile estimates were within 10% of the actual birth weight percentile approximately 50% of the time. Multiple ultrasonographic examinations provided little improvement in prediction of birth weight compared with a single observation. Multiple measurements of the abdominal circumference percentile may provide improved accuracy in identifying large for gestational age and small for gestational age fetuses. (AM J Obstet Gynecol 1994;170:1600-6.)     

Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome

OBJECTIVE: The purpose of this study was to evaluate the antenatal umbilical cord coiling index obtained during the fetal anatomic survey in the second trimester as a predictor of adverse pregnancy outcome. STUDY DESIGN: Four hundred twenty-five consecutive women who had a fetal anatomic survey between 18 to 23 weeks of gestation were evaluated for umbilical cord coiling. The antenatal umbilical cord coiling index was calculated as a reciprocal value of the distance between a pair of coils (antenatal umbilical cord coiling index = 1/distance in cm) and was correlated with the following adverse pregnancy outcomes: (1) small for gestational age, (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) presence of nonreassuring fetal status in labor, and (5) Apgar scores at 1 and 5 minutes. RESULTS: A total of 294 patients had adequate ultrasound images and all antenatal and labor data to meet the study inclusion criteria. Abnormal coiling was associated significantly with small for gestational age neonates at birth (P = .043) and non-reassuring fetal status in labor (P = .007). Nine of 58 neonates (15.5%) with abnormal umbilical coiling were small for gestational age infants compared with 15 of 236 small for gestational age neonates (6.4%) who had normal cord coiling. A non-reassuring fetal status in labor was observed in 25.7% of fetuses (15/58 fetuses) with abnormal umbilical coiling compared with 11.0% of fetuses (26/236 fetuses) with normal cord coiling. In contrast, no statistical difference for Apgar scores at 1 and 5 minutes or higher prevalence of interventional deliveries and meconium-stained amniotic fluid in labor between the groups with normal and abnormal umbilical cord coiling was observed. CONCLUSION: Abnormal umbilical cord coiling that is detected at the fetal ultrasound anatomic survey in the second trimester is associated with a higher prevalence of small for gestational age neonates and non-reassuring fetal status in labor. This observation can be used potentially as a predictor of adverse antenatal or perinatal events in future studies.     

Intrapartum assessment of fetal well-being: a comparison of fetal acoustic stimulation with acid-base determinations

Many authorities advocate the use of fetal blood sampling as the final arbiter of abnormal intrapartum fetal heart rate patterns. Alternatively, the presence of an acceleratory fetal heart rate response to scalp stimulation during fetal scalp blood sampling led to the observation that, if present, the likelihood of acidosis was remote. Consequently a prospective intrapartum analysis of evoked accelerations and fetal acid-base status was undertaken. Patients who, on the basis of abnormal fetal heart rate patterns, were judged candidates for acid-base assessment underwent transabdominal acoustic stimulation. The presence or absence of an acceleration was then determined. Sixty-four patients with abnormal intrapartum fetal heart rate patterns underwent intrapartum acoustic stimulation. Thirty fetuses were reactive and all had a pH of greater than or equal to 7.25. Of the 34 fetuses who were nonreactive, 18 were acidotic. This preliminary observation suggests that acoustic stimulation may be a reasonable clinical alternative to fetal blood sampling when a reactive pattern is observed. In the nonreactive fetuses additional evaluation would appear warranted.