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Biophysical and biochemical markers at 35–37 weeks' gestation in the prediction of adverse perinatal outcome
Author(s) -
Valiño N.,
Giunta G.,
Gallo D. M.,
Akolekar R.,
Nicolaides K. H.
Publication year - 2016
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.15663
Subject(s) - medicine , fetal distress , umbilical artery , gestation , fetus , obstetrics , apgar score , umbilical cord , small for gestational age , gestational age , uterine artery , pregnancy , birth weight , labor induction , genetics , anatomy , oxytocin , biology
Objective To investigate the potential value of biophysical and biochemical markers at 35–37 weeks' gestation in the prediction of adverse perinatal outcome. Methods This was a screening study in 3953 singleton pregnancies at 35–37 weeks' gestation. Estimated fetal weight ( EFW ), uterine artery pulsatility index ( UtA‐PI ), umbilical artery ( UA )‐ PI , fetal middle cerebral artery ( MCA )‐ PI , mean arterial pressure ( MAP ), serum placental growth factor ( PlGF ) and soluble fms‐like tyrosine kinase‐1 ( sFlt ‐1) were measured. The detection rate ( DR ) and false‐positive rate ( FPR ) of screening by each biomarker were estimated for pre‐eclampsia ( PE ), delivery of small‐for‐gestational‐age ( SGA ) neonates, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1, 5‐min Apgar score < 7 and admission to the neonatal unit ( NNU ). Results Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF , sFlt ‐1 and MAP , with a DR of 73% at a 10% FPR . Prediction of SGA was provided by EFW , PlGF and UtA‐PI , with a DR of 63% at a 10% FPR . Prediction of Cesarean section for fetal distress before labor was provided by EFW and UA‐ PI with DR of 100% at 10% FPR . Prediction of fetal distress in labor was provided by EFW and sFlt ‐1, with a DR of 15% at a 10% FPR . There were no significant differences between those with a normal outcome and those with low cord blood pH , low Apgar score or NNU admission for any of the biomarkers assessed. Conclusion At 35–37 weeks' gestation biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE , SGA and fetal distress before labor, but poor or no prediction of adverse events in labor or after birth. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.