Fetal Myocardial Performance Index in the Late Third Trimester for the Prediction of Intrapartum Cardiotocographic Abnormalities

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-09-18 DOI:10.1111/echo.70300

Sikolia Z. Wanyonyi, Ingrid Gichere

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引用次数: 0

Abstract

Objective

We sought to determine whether fetal myocardial performance index (MPI) performed in the late third trimester could predict abnormal intrapartum cardiotocographic (CTG) patterns.

Methods

A prospective observational study including women presenting for fetal growth ultrasound from 32 weeks. Three consecutive measurements of the left ventricular MPI were obtained and averaged. The patients’ intrapartum CTG events were later observed.

Results

A total of 299 women were analyzed. The fetal MPI across the population were 0.41, 0.50 and 0.63, representing 10th, 50th and 90th centiles, respectively. A one-way analysis of variance (ANOVA) did not show a significant difference in MPI values across intrapartum findings for normal, suspicious and pathological CTGs [F (3, 298) = 0.417, p = 0.57], and upon logistic regression, no relationship was observed between MPI and abnormal intrapartum CTG: odds ratio (OR) 2.15; 95% confidence interval (95% CI) (0.036–160.9); p = 0.718. There was also no difference in mean fetal MPI for those women who had pre-eclampsia [0.36; 95% CI (-0.04 to 0.05); p = 0.76], gestational diabetes [t (57.31) = -0.34, p = 0.73] and fetal growth restriction [0.49; 95% CI (-0.02 to 0.06); p = 0.56] compared to the low-risk women. Furthermore, MPI had a modest sensitivity (62.5%) and specificity (50.9%) with a positive and negative predictive value of 31.3% and 79.2%, respectively, for detecting abnormal intrapartum CTG. The discriminatory ability of MPI for abnormal CTG was also poor (AUC = 0.53), besides having minimal diagnostic value (positive likelihood ratio of 1.27% and negative predictive value of 0.74%). No association was found between fetal MPI and admission to neonatal intensive care unit: OR 0.53; 95% CI (0.19–1.51).

Conclusion

Fetal MPI obtained in the late third trimester is a poor predictor for abnormal intrapartum fetal heart patterns and neonatal outcomes.

Summary

Myocardial performance index is higher in fetuses with fetal growth restriction, obstetric cholestasis, gestational diabetes mellitus and is associated with adverse perinatal outcomes.
Myocardial hypoxia could lead to abnormal intrapartum fetal heart rate patterns on cardiotocogram.
There is no correlation between a high myocardial performance index and intrapartum cardiotocographic abnormalities.

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妊娠晚期胎儿心肌功能指数对产时心脏学异常的预测。

目的：我们试图确定在妊娠晚期进行的胎儿心肌表现指数（MPI）是否可以预测异常的产时心图（CTG）模式。方法：一项前瞻性观察研究，包括32周的孕妇进行胎儿生长超声检查。连续三次测量左心室MPI并取平均值。随后观察患者产时CTG事件。结果：共分析了299名女性。整个种群的胎儿MPI分别为0.41、0.50和0.63，分别代表第10、50和90百分位。单因素方差分析（ANOVA）未显示产时正常、可疑和病理CTG的MPI值有显著差异[F (3,298) = 0.417, p = 0.57]，经logistic回归，MPI与产时异常CTG之间没有关系：比值比（OR） 2.15；95%置信区间（95% CI）（0.036-160.9）；P = 0.718。子痫前期妇女的平均胎儿MPI也没有差异[0.36；95% CI (-0.04 ~ 0.05)；P = 0.76]、妊娠期糖尿病[t (57.31) = -0.34, P = 0.73]、胎儿生长受限[0.49]；95% CI (-0.02 ~ 0.06)；P = 0.56]与低风险女性相比。此外，MPI检测产时异常CTG的敏感性为62.5%，特异性为50.9%，阳性预测值为31.3%，阴性预测值为79.2%。MPI对CTG异常的鉴别能力也较差（AUC = 0.53），诊断价值很小（阳性似然比为1.27%，阴性预测值为0.74%）。胎儿MPI与新生儿重症监护病房入院无关联：OR 0.53；95% ci（0.19-1.51）。结论：在妊娠晚期获得的胎儿MPI不能很好地预测异常的产时胎儿心脏模式和新生儿结局。摘要：患有胎儿生长受限、产科胆汁淤积、妊娠期糖尿病的胎儿心肌功能指数较高，并与不良围产期结局相关。心肌缺氧可导致产时胎儿心率异常。高心肌表现指数与产时心电图异常之间没有相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.