P05.21: Monitoring of fetuses with intrauterine growth restriction: an observational study for the evaluation of new predictive parameters

To identify a set of parameters improving the early detection of fetal distress conditions starting from indexes, which can be obtained in a standard noninvasive monitoring session. In fetuses with intrauterine growth restriction (IUGR) accuracy of methods and algorithms for the extraction of quantitative information from fetal heart rate (FHR) data and echographic recordings were evaluated. We propose a new methodological approach for the CTG monitoring, based on a multiparametric FHR analysis, which includes spectral parameters from autoregressive models and nonlinear algorithms (Approximate Entropy (ApEn)). Moreover we evaluated Doppler flow parameters (PI umbelical artery (UA) and middle cerebral artery (MCA)) and Amniotic Fluid Index (AFI). The computerized cardiotocographic and sonographic parameters recorded within 24 h of delivery were correlated to perinatal outcome. The multiparametric analysis previously described was performed in 46 singleton pregnancies with IUGR fetuses, delivered at 26–36 wks of gestation. Of these 15 fetuses had an APGAR score < 5 at 5 min or an adverse perinatal outcome (adverse outcome group). ApEn results significantly higher in IUGR fetuses with adverse outcome (1.29 ± 0.6 vs 1.15 ± 0.14). UA PI > 90th centile occurred in 10/15 (66.6%) IUGR fetuses of adverse outcome group and in 11/31 (35.4%) of the normal outcome group. Whereas ApEn > 2 SD was observed in 14/15 (93.3%) IUGR fetuses of the adverse outcome group. AFI < 10th centile was recorded in 89.1% of all IUGR fetuses and PI MCA < 10th centile in 78.2%. Mean values of MCA PI and AFI were not significantly different in IUGR fetuses with normal and adverse outcome. These results proposes a possible new marker for the diagnosis of fetal distress that associated with the sonographic flow Doppler may be predictive of adverse outcome in IUGR fetuses.