OP04.04: Maternal hemodynamics and computerised CTG in the identification of risk during labour

To verify if the hemodynamic assessment, ultrasound examination, computerised cardiotocography analysis (cCTG) or hematochemical test of "low risk" pregnant women at term can improve the identification of patients with a maternal or fetal complication during labour. We enrolled 396 women at the term of pregnancy (mean GA: 39 weeks + 3 days), not in labour and without a fetal or maternal disease. We collected anamnestic information, hematochemical values, maternal hemodynamic assessment (performed by USCOM method), cCTG analysis (mean duration: 36.4 min), and ultrasound parameters (fetal middle cerebral and umbilical artery Doppler velocimetry, uterine artery Doppler velocimetry and amniotic fluid index). After the childbirth (mean GA: 40 weeks + 2 days), we gathered information about the delivery in order to detect adverse outcome (c-section or vaginal operative delivery for non-reassuring or pathological CTG, major post-partum hemorrhage, 5-min Apgar score < 7 min, NICU admission). We observed adverse outcomes in 44 patients (11.11%). Patients with complications during labour showed higher values of systemic vascular resistance (SVR) (1368.44±231.14 vs 1260.63±271.60 d.s.cm-5, p < 0.05) and lower values of cardiac output (CO) (5.38±0.78 vs 5.80±1.20 l/min, p < 0.05), compared to uncomplicated patients. The ROC curve analysis showed a cut-off for SVR ≥ 1138 d.s.cm-5 (Se 0.93, Sp 0.36) and CO ≤ 5.58 (Se 0.68, Sp 0.53) to predict labour complications. Using the cut off obtained, we calculated the OR for SVR ≥ 1138 d.s.cm-5 (OR 7.65, p < 0.01), CO ≤ 5.58 l/min (OR 2.39, p = 0.01), short term variability ≤ 7.0 ms (OR 3.64, p = 0.03), length high variation episodes ≤ 7,0 min (OR 4.37, p = 0.02). The US examination, hematochemical blood test and anamnestic parameters, haven't been useful to predict adverse outcomes. The study of maternal cardiovascular adaptation at the end of pregnancy might identify patients at risk during labour. In particular, a low CO and high SVR are associated with a higher risk of fetal distress or maternal complications. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.