Maternal cardiovascular function and risk of intrapartum fetal compromise in women undergoing induction of labor: pilot study

Date

2020-08-01

Author

Kalafat, E.
Barratt, I.
Nawaz, A.
Thilaganathan, B.
Khalil, A.

Metadata

Show full item record

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Item Usage Stats

287
views

0
downloads

Objective Identification of the fetus at risk of intrapartum compromise has many benefits. Impaired maternal cardiovascular function is associated with placental hypoperfusion predisposing to intrapartum fetal distress. The aim of this study was to assess the predictive accuracy of maternal hemodynamics for the risk of operative delivery due to presumed fetal compromise in women undergoing induction of labor (IOL). Methods In this prospective cohort study, patients were recruited between November 2018 and January 2019. Women undergoing IOL were invited to participate in the study. A non-invasive ultrasonic cardiac output monitor (USCOM-1A (R)) was used for cardiovascular assessment. The study outcome was operative delivery due to presumed fetal compromise, which included Cesarean or instrumental delivery for abnormal fetal heart monitoring. Regression analysis was used to test the association between cardiovascular markers, as well as the maternal characteristics, and the risk of operative delivery due to presumed fetal compromise. Receiver-operating-characteristics-curve analysis was used to assess the predictive accuracy of the cardiovascular markers for the risk of operative delivery for presumed fetal compromise. Results A total of 99 women were recruited, however four women were later excluded from the analysis due to semi-elective Cesarean section (n = 2) and failed IOL (n = 2). The rate of operative delivery due to presumed fetal compromise was 28.4% (27/95). Women who delivered without suspected fetal compromise (controls) were more likely to be parous, compared to those who had operative delivery due to fetal compromise (52.9%vs18.5%;P = 0.002). Women who underwent operative delivery due to presumed fetal compromise had a significantly lower cardiac index (median, 2.50vs2.60 L/min/m(2);P = 0.039) and a higher systemic vascular resistance (SVR) (median, 1480vs1325 dynes x s/cm(5), P = 0.044) compared to controls. The baseline model (being parous only) showed poor predictive accuracy, with an area under the curve of 0.67 (95% CI, 0.58-0.77). The addition of stroke volume index (SVI) 7.2 logs or SVR index (SVRI) > 7.7 logs improved significantly the predictive accuracy of the baseline model (P = 0.012,P = 0.026 andP = 0.012, respectively). Conclusion In this pilot study, we demonstrated that prelabor maternal cardiovascular assessment in women undergoing IOL could be useful for assessing the risk of intrapartum fetal compromise necessitating operative delivery. The addition of SVI, SVR or SVRI improved significantly the predictive accuracy of the baseline antenatal model. Copyright (c) 2019 ISUOG. Published by John Wiley & Sons Ltd.

Subject Keywords

Obstetrics and Gynaecology, Radiological and Ultrasound Technology, Radiology Nuclear Medicine and imaging, Reproductive Medicine, General Medicine

URI

https://hdl.handle.net/11511/67956

Journal

ULTRASOUND IN OBSTETRICS & GYNECOLOGY

DOI

https://doi.org/10.1002/uog.21918

Collections

Department of Statistics, Article

Suggestions

OpenMETU
Core

Is home blood-pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings? Kalafat, E.; Mir, I.; Perry, H.; Thilaganathan, B.; Khalil, A. (Wiley, 2018-10-01) Objective To assess the agreement between home blood-pressure monitoring (HBPM) and blood-pressure measurements in a clinic setting, in a cohort of pregnant women with hypertensive disorders of pregnancy (HDP).
The outcome of the multifetal pregnancy reduction procedures in a single centre: A report of 202 completed cases Yilanhoglu, Necip Cihangir; Semiz, Altug; Arisoy, Resul; Kahraman, Semra; Gurkan, Ali Arslan (Elsevier BV, 2018-11-01) Objective: To review the results of fetal reduction procedures in our institution, evaluate its effects on the pregnancy outcome in terms of miscarriage, preterm delivery, taking home healthy babies and discuss the factors that may have contributed to the outcome.
Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: an internally validated prediction model Kalafat, Erkan; Morales-Rosello, Jose; Thilaganathan, Basky; Tahera, Fathema; Khalil, Asma (Elsevier BV, 2018-01-01) BACKGROUND: Small-for-gestational-age fetuses are at an increased risk of intrapartum fetal compromise requiring operative delivery. Factors associated with the risk of intrapartum fetal compromise are yet to be established, and a comprehensive model accounting for both the antenatal and intrapartum variables is lacking.
Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy A Systematic Review and Meta-Analysis Johnson, Sonia; Liu, Becky; Kalafat, Erkan; Thilaganathan, Basky; Khalil, Asma (Ovid Technologies (Wolters Kluwer Health), 2020-07-01) The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE,, and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women wit...
Ophthalmic artery Doppler for prediction of pre-eclampsia: systematic review and meta-analysis KALAFAT, ERKAN; Laoreti, A.; Khalil, A.; Costa, F. Da Silva; Thilaganathan, B. (Wiley, 2018-06-01) Objective To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE).

Citation Formats

E. Kalafat, I. Barratt, A. Nawaz, B. Thilaganathan, and A. Khalil, “Maternal cardiovascular function and risk of intrapartum fetal compromise in women undergoing induction of labor: pilot study,” ULTRASOUND IN OBSTETRICS & GYNECOLOGY, pp. 233–239, 2020, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/67956.