Fetal monitoring in pregnancies at and beyond 41 completed weeks: Prospective blind observational study of the use of umbilical and middle cerebral artery Doppler

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction Pub Date : 2026-01-01 Epub Date: 2025-10-15 DOI:10.1016/j.jogoh.2025.103054

Jeremy Boujenah, Bernard Benoit, Reda Djafer, Jacques Raiga, Guillaume Benoist, Bruno Carbonne

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引用次数: 0

Abstract

Objectives

To assess the association of umbilical and middle cerebral artery Doppler, with the need for medical intervention during labor and the occurrence of adverse neonatal outcome in pregnancies at/or beyond 41 weeks.

Methods

Prospective, observational study of all pregnant women at 41 weeks and beyond during one year in a single Maternity Unit. Doppler measurements of umbilical artery and middle cerebral artery resistance indices (UA-RI and MCA-RI) and cerebro placental ratio (CPR) were performed at 41 weeks, blinded to the clinical staff. Clinical management of prolonged pregnancy was based on routine antepartum fetal heart rate (FHR) monitoring and ultrasound assessment of oligohydramnios. The main outcome measures were 2 composite criteria: 1) “medical intervention during labor” including any of cesarean delivery for FHR abnormalities and/or need for fetal scalp blood sampling for lactate measurement; and 2) “suboptimal neonatal outcome” including any of 5-min Apgar score < 7, umbilical cord artery pH < 7.15, transfer to neonatal unit or perinatal death. The association between abnormal fetal Doppler and the outcome criteria was assessed.

Results

Out of 116 women recruited (12.3 % of all deliveries), 30 (25.9 %) had a medical intervention during labor and 16 (13.8 %) had a suboptimal neonatal outcome. None of antepartum FHR or oligohydramnios were associated with any of the primary outcomes. UA-RI and cerebro-placental ratio were strongly associated with the need for a medical intervention during labor (OR [95 % CI] 13.1 [1.4 – 122.2] and 5.1 [1.3 19.7], respectively) but not with the occurrence or a suboptimal neonatal outcome. If made available to the clinical staff, abnormal fetal Dopplers could have led to 12 additional inductions of labor and to the adequate identification of 13 interventions during labor including 6 cesareans for abnormal FHR.

Conclusion

Abnormal fetal Doppler beyond 41 weeks may help to better identify situations at risk for medical intervention for fetal concern during labor. Further studies are necessary to assess its prospective use for the management of prolonged pregnancies

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41周及以上妊娠期胎儿监测：脐带和大脑中动脉多普勒应用的前瞻性盲观察研究

目的：评估妊娠41周及以上产妇产程中脐带和大脑中动脉多普勒与医疗干预的需要和新生儿不良结局的发生的关系。方法：前瞻性，观察性研究所有41周及以上的孕妇在一个单一的产科病房一年。41周时，在临床工作人员不知情的情况下，进行脐动脉和大脑中动脉阻力指数（UA-RI和MCA-RI）和脑胎盘比（CPR）的多普勒测量。延长妊娠的临床处理以产前常规胎心率监测和羊水过少超声评估为基础。主要结局指标为2个综合标准：1)“分娩过程中的医疗干预”，包括因FHR异常和/或需要进行胎儿头皮血液采样以测量乳酸含量的剖宫产；2)“新生儿预后欠佳”，包括5分钟Apgar评分< 7、脐带动脉pH < 7.15、转至新生儿病房或围产期死亡。评估胎儿多普勒异常与预后标准之间的关系。结果：在所招募的116名妇女（占所有分娩的12.3%）中，30名（25.9%）在分娩期间进行了医疗干预，16名（13.8%）的新生儿结局不理想。产前FHR或羊水过少与任何主要结局均无关联。UA-RI和脑胎盘比与分娩期间医疗干预的需要密切相关（OR [95% CI]分别为13.1[1.4 - 122.2]和5.1[1.3 - 19.7]），但与新生儿结局的发生或次优结局无关。如果对临床工作人员可用，异常的胎儿多普勒将导致12次额外的引产，并在分娩过程中充分识别13种干预措施，包括6次因异常FHR而进行的剖腹产。结论：41周以上胎儿多普勒异常可能有助于更好地识别分娩过程中胎儿关注的危险情况。需要进一步的研究来评估其在长期妊娠管理中的应用前景。

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

Journal of gynecology obstetrics and human reproduction Medicine-Obstetrics and Gynecology

CiteScore

3.70

自引率

5.30%

发文量

210

审稿时长

31 days

期刊介绍： Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF). J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines. Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.