Intrapartum prediction of emergency delivery due to non-reassuring fetal status at 40 weeks’ gestation in low-risk pregnancies: contribution of Doppler parameters, maternal history, and intrapartum clinical characteristics

Abstract

Objective

To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies.

Methods

This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks’ gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).

Results

From 403 included pregnancies, 18.6% (n = 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 versus 1.30; p < .001, and 1.61 versus 1.78; p = .001, respectively). There was a higher incidence of small-for-gestational-age neonates (20 versus 10.1%; p = .017), lower Apgar scores at the 5th minute (9.7 versus 9.9; p = .006), and NICU admissions (9 versus 3%; p = .016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p = .008).

Conclusions

In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.

Keywords:

• Appropriate-gestational-age
• cerebroplacental ratio
• fetal Doppler
• middle cerebral artery
• small-gestational-age

Author contributions

All the authors had a substantial contribution with specific responsibilities.

Francesca Crovetto was responsible for conception and design of the work, analysis and interpretation of data, critically revision and final approval; Nicola Cesano, Federica Rossi, Stefano Acerboni, Stefano De Marinis had a substantial role in the acquisition of data; Annachiara Basso, Raigam Jafet Martinez Portilla, Rosalia Pascal Capdevila had a substantial contribution for writing and drafting of the work and analysis of data; Barbara Acaia, Luigi Fedele, Enrico Ferrazzi, Nicola Persico were responsible for the final revision and approval of the version to be published.

Any part of the work was appropriately investigated and approved by the authors.

Disclosure statement

No potential conflict of interest was reported by the authors.