Comparison of the intrapartum analysis of Doppler blood flow velocity waveform of the umbilical artery and fetal heart rate tracing for the prediction of perinatal outcome.

This study was performed to determine the value of umbilical artery Doppler flow velocity waveform (FVW) analysis and fetal heart rate (FHR) tracing in the course of labour for predicting poor perinatal outcome. The randomised, controlled and prospective study was carried out on 99 singleton term pregnant women in labour at the Zeynep Kamil Women and Children's Hospital, Istanbul. All patients were evaluated by both methods during the intrapartum period. Blood gases and pH of umbilical venous blood and 1 and 5 minute Apgar scores of the newborn infants were determined immediately after delivery. For the prediction of poor perinatal outcome, the sensitivity, specificity, negative predictive value and positive predictive value of FHR were 72.0%, 85.1%, 60.1% and 90.0%, respectively. FHR was pathological in all four cases with a neonatal death, whereas only two had pathological Doppler FVW. We conclude that FHR is a more sensitive method than umbilical artery Doppler FVW analysis (72.0% versus 36.0%) in the prediction of poor perinatal outcome during the intrapartum period. A combination of the two tests increases the specificity of the prediction of poor perinatal outcome from 89.2% and 85.1% to 94.9%. High negative predictive values of both tests should reassure the clinician when the test results are normal.