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Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses.
Lancet. 1992 Oct 17; 340(8825):936-40.Lct

Abstract

Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Danderyd's Hospital, Karolinska Institutet, Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

1357349

Citation

Almström, H, et al. "Comparison of Umbilical-artery Velocimetry and Cardiotocography for Surveillance of Small-for-gestational-age Fetuses." Lancet (London, England), vol. 340, no. 8825, 1992, pp. 936-40.
Almström H, Axelsson O, Cnattingius S, et al. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet. 1992;340(8825):936-40.
Almström, H., Axelsson, O., Cnattingius, S., Ekman, G., Maesel, A., Ulmsten, U., Arström, K., & Marsál, K. (1992). Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet (London, England), 340(8825), 936-40.
Almström H, et al. Comparison of Umbilical-artery Velocimetry and Cardiotocography for Surveillance of Small-for-gestational-age Fetuses. Lancet. 1992 Oct 17;340(8825):936-40. PubMed PMID: 1357349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. AU - Almström,H, AU - Axelsson,O, AU - Cnattingius,S, AU - Ekman,G, AU - Maesel,A, AU - Ulmsten,U, AU - Arström,K, AU - Marsál,K, PY - 1992/10/17/pubmed PY - 1992/10/17/medline PY - 1992/10/17/entrez SP - 936 EP - 40 JF - Lancet (London, England) JO - Lancet VL - 340 IS - 8825 N2 - Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/1357349/Comparison_of_umbilical_artery_velocimetry_and_cardiotocography_for_surveillance_of_small_for_gestational_age_fetuses_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0140-6736(92)92818-Z DB - PRIME DP - Unbound Medicine ER -