Abstract
Aim: To evaluate whether computerized CTG (cCTG) is a reliable method of predicting neonatal outcome in pregnancies complicated by pregestational diabetes at term.
Patients and methods: We considered 27 pregnant women affected by pregestational diabetes and 46 normal pregnancies as controls that fulfilled the following criteria: singleton, Caucasian, euglycemic pregnancies at term (>37 weeks gestational age). All women delivered by cesarean section (CS), with an antepartum cCTG performed within one hour before the CS and an UBGA available at birth. No patient was in labor during FHR monitoring.
Results: Among cCTG parameters, accelerations 15 bpm, HV min, HV ms and STV were significantly lower in comparison to controls. We observed that in the diabetic pregnant women the parameter STV was not able to predict or to linearly regress with the most important UBGA parameters: pH and pCO2. Contrarily, in normal pregnancies, the STV linearly regressed with both the pH (p < 0.03) and pCO2 (p < 0.04).
Conclusions: Computerized FHR criteria may not be applicable to fetuses in pregestational diabetic pregnancies at term. Therefore some criteria should perhaps be modified for a correct interpretation of cCTG in these pregnancies.
References
1 Anceschi MM, JJ Piazze, G Vozzi, A Ruozi-Berretta, C Figliolini, R Vigna, EV Cosmi: Antepartum computerized CTG and neonatal acid-base status at birth. Int J Gynecol Obstet65 (1999) 267Search in Google Scholar
2 Anceschi MM, JJ Piazze, A Ruozi-Berretta, E Cosmi, A Cerekja, L Maranghi, EV Cosmi: Validity of short term variation (STV) in detection of fetal acidemia. J Perinat Med31 (2003) 231Search in Google Scholar
3 Andreas RL, G Saade, LC Gilstrap, I Wilkins, A Witlin, F Zlatnik, GV Hankins: Association between umbilical blood gas parameters and neonatal morbidity and death with patological fetal acidemia. Am J Obstet Gynecol181 (1999) 867Search in Google Scholar
4 Ayromlooi J, LI Mann, RR Weiss, NA Tejani, M Paydar: Modern management of the diabetic pregnancy. Obstet Gynecol49 (1977) 137Search in Google Scholar
5 Belai I, TM Goodwin, M Durand, JS Greenspoon, RH Paul, FJ Walters: Umbilical arteriovenous pO2 and pCO2 differences and neonatal morbidity in term infants with severe acidosis. Am J Obstet Gynecol178 (1998) 13Search in Google Scholar
6 Bradley RJ, KH Nicolaides, JM Brudenell: Fetal acidosis and hyperlactacidemia diagnosed by cordocentesis in pregnancies complicated by maternal diabetes mellitus. Diab Med8 (1991) 464Search in Google Scholar
7 Kari T, A Pirkko, Y Kari, OR Kari: Pathologic fetal heart rate associated with poor metabolic control in diabetic pregnancies. Obstet Gynecol61 (1983) 559Search in Google Scholar
8 Low JA, C Panagiotopoulos, EJ Derrick: Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol170 (1994) 1081Search in Google Scholar
9 Low JA: Intrapartum fetal asphyxia: definition, diagnosis, and classification. Am J Obstet Gynecol176 (1997) 95710.1016/S0002-9378(97)70385-5Search in Google Scholar
10 Salvesan DR, J Freeman, JM Brudenell, KH Nicolaides: Prediction of fetal acidemia in pregnancies complicated by diabetes mellitus by biophysical profile scoring and fetal heart rate monitoring. Br J Obstet Gynaecol100 (1993) 227Search in Google Scholar
11 Teramo K, P Ammala, K Ylinen, KO Raivio: Pathologic fetal heart rate associated with poor metabolic control in diabetic pregnancies. Obstet Gynecol61 (1983) 559Search in Google Scholar
12 Tincello D, S White, S Walkinshaw. Computerized analysis of fetal heart rate recordings in maternal type I diabetes mellitus. Br J Obstet Gynaecol108 (2001) 853Search in Google Scholar
13 Tincello DG, KM El-Sapagh, SA Walkinshaw: Computerised analysis of fetal heart rate recordings in patients with diabetes mellitus: the Dawes-Redman criteria may not be valid indicators of fetal well-being. J Perinat Med26 (1998) 102Search in Google Scholar
14 Van den Berg PP, WLDM Nelen, HW Jongsma, R Nijland, LAA Kollèe, JG Nijhuis, T Eskes: Neonatal complications in newborns with an umbilical artery pH<7.00. Am J Obstet Gynecol175 (1996) 1152Search in Google Scholar
15 Weiner Z, I Thaler, G Farmakides, Y Barnhard, D Maulik, MY Divon: Fetal heart rate patterns in pregnancies complicated by maternal diabetes. Eur J Obstet Gynecol Reprod Biol70 (1996) 111Search in Google Scholar
16 Whittle M, D Anderson, RI Lowensohn, JH Mestman, RH Paul, U Goebelsmann: Estriol in pregnancy.VI. Experience with unconjugated plasma estriol assays and antepartum fetal heart rate testing in diabetic pregnancies. Am J Obstet Gynecol135 (1979) 764Search in Google Scholar
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