Background Fetuses with intrauterine growth retardation aredelivered if they have evidence of distress, as manifested byabnormalities in the fetal heart rate and umbilical-artery bloodflow. We studied whether umbilical-blood sampling might providefurther information useful for management.
Methods We measured hemoglobin and lactate concentrations, oxygencontent, pH, blood gas levels, and base deficit in umbilical-veinblood and correlated these measurements with the heart rateand umbilical-artery wave forms recorded by Doppler velocimetryin 56 fetuses with growth retardation. Twenty-one fetuses hadnormal heart rates and normal results of velocimetry, 24 hadnormal heart rates and abnormal results of velocimetry (indicativeof decreased diastolic flow), and 11 had abnormal heart ratesand abnormal results of velocimetry.
Results None of the 21 fetuses with normal heart rates and velocimetryhad hypoxia or acidemia. Of the 24 fetuses with normal heartrates and abnormal velocimetry, 4 (17 percent) had moderatelactic acidosis, 1 (4 percent) had a low pH value, and 3 (12percent) had hypoxia. Of the 11 fetuses with abnormal heartrates and velocimetry, 7 (64 percent) had lactic acidosis, lowblood oxygen content, and low pH values. The absence of end-diastolicflow increased the risk of hypoxia and acidemia. The proportionof fetuses with elevated hemoglobin concentrations was similaramong the three groups.
Conclusions Assessment of fetal oxygenation and acid-base balanceis not indicated in fetuses with growth retardation if theirheart rates and the results of velocimetry are normal. If theresults of velocimetry are abnormal, fetal-blood sampling candistinguish fetuses that have growth retardation alone fromthose that also have hypoxia and acidosis, and thus may aidin determining the optimal time of delivery.
Source Information
From the Department of Obstetrics and Gynecology, San Paolo Institute of Biomedical Sciences, University of Milan, Italy (G.P., I.C., A.M.M., A.L., P.B., E.F., M.B.), and the Division of Perinatal Medicine, Department of Pediatrics, University of Colorado School of Medicine, Denver (F.C.B.).
Address reprint requests to Dr. Pardi at the Department of Obstetrics and Gynecology, University of Milan, H. San Paolo, Via A. di Rudini, 8, 20142 Milan, Italy.
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