Use multiple modalities for monitoring in growth-restricted fetuses: Doppler, biophysical profiles.(Obstetrics)

LISBON -- Use a combination of monitoring techniques to help determine the appropriate timing for delivery of a growth-restricted fetus, Dr. Ahmet Baschat advised at a world congress sponsored by the Fetal Medicine Foundation.

Besides traditional or computerized cardiotocography to monitor the fetal heart rate, biophysical parameters and multivessel Doppler each can provide unique information useful for decision making. In some cases, each technique can compensate for shortcomings in the other techniques, said Dr. Baschat of the University of Maryland, Baltimore.

The use of biophysical parameters to develop a biophysical profile score is good for monitoring a growth-restricted fetus because the cutoffs used in scoring account for the normal physiologic variations of gestation. Such scoring has been shown in numerous studies to correlate with both short-term and long-term outcomes. But the biophysical profile score lacks longitudinal accuracy; in growth-restricted fetuses, the sole use of biophysical parameters for monitoring is inadequate, Dr. Baschat said.

Furthermore, the score deteriorates late. "If you wait until [the score] goes bad, you are delivering a half-dead baby," he said.

Doppler studies can identify problems earlier and have been shown to be predictive of stillbirth. If you choose to use Doppler alone for monitoring, you must be able to do multivessel Doppler because the umbilical artery and middle cerebral artery provide unique information about the fetal condition. By using both biophysical parameters and Doppler, better assessment of fetal status can be achieved. He called this approach "integrative fetal testing."

First, intrauterine growth restriction is diagnosed based on small abdominal circumference or decreased longitudinal growth of less than 11 mm in 2 weeks associated with elevated blood flow resistance in the umbilical artery. Fetuses with growth ...