I.R. Lange

Ultrasound evaluation of amniotic fluid volume

Qualitative amniotic fluid volume determination is a routine part of fetal biophysical profile score testing. The relationship between oligohydramnios and poor perinatal outcome has been previously documented. We have undertaken a retrospective chart review relating qualitative amniotic fluid volume as determined at the time of last biophysical profile score assessment to perinatal outcome in 7582 referred high-risk obstetric patients. Gross and corrected perinatal mortality in association with normal qualitative amniotic fluid volume ranged from 4.65/1000 and 1.97/1000, respectively, to 187.5/1000 and 109.4/1000 in association with decreased qualitative amniotic fluid volume, respectively. The incidences of major congenital anomaly and intrauterine growth retardation were significantly related to qualitative amniotic fluid volume.

Fetal assessment based on fetal biophysical profile scoring: Experience in 12,620 referred high-risk pregnancies: I. Perinatal mortality by frequency and etiology

Fetal biophysical profile scoring was used as a method for antepartum fetal risk assessment in 12,620 high-risk patients referred in a 55-month interval. A total of 26,257 tests were performed on these patients (range, one to 18 tests per patient). Ninety-three perinatal deaths occurred (gross perinatal mortality rate, 7.37 per 1000) of which 62 (66.6%) were due to a major anomaly, seven were due to Rh disease (7.5%), and the remaining 24 deaths (25.8%) occurred in structurally normal fetuses. The corrected perinatal mortality rate was 1.90 per 1000. Eight structurally normal fetuses died within 1 week of a normal test result (corrected false negative rate, 0.634 per 1000). These data suggest fetal biophysical profile scoring is an accurate method for identification of the fetus at risk for perinatal death.

Ultrasound evaluation of amniotic fluid volume: II. The relationship of increased amniotic fluid volume to perinatal outcome

Qualitative amniotic fluid volume determination is a routine part of fetal biophysical profile score testing. The relationship between polyhydramnios and poor perinatal outcome has been previously documented. We have undertaken a retrospective chart review which relates qualitative amniotic fluid volume as determined at the time of last biophysical profile score assessment to perinatal outcome in 7562 referred high-risk obstetric patients. Gross and corrected perinatal mortality in association with normal qualitative amniotic fluid volume ranged from 4.65/1000 and 1.97/1000, respectively, to 32.9/1000 and 4.12/1000 in association with increased qualitative amniotic fluid volume, respectively. The incidences of major congenital anomaly and fetal macrosomia were significantly related to qualitative amniotic fluid volume.

Fetal biophysical profile scoring: A prospective study in 1,184 high-risk patients

The results of a prospective clinical management based on fetal biophysical profile scoring method was evaluated in 1,184 referred high-risk patients. Six perinatal deaths occurred in the study group (perinatal mortality of 5.06 per 1,000); only one fetus suffered unpredictable and unpreventable death (true false negative rate 0.8 per 1,000). In addition, 13 fetuses with major congenital anomalies were detected as a result of ultrasound scanning for fetal biophysical activities. These data suggest that this method can be used effectively to screen and manage a high-risk population.

Fetal assessment based on fetal biophysical profile scoring: IV. An analysis of perinatal morbidity and mortality

The relationship between the last biophysical profile score result and perinatal outcome was determined among a large referred population of high-risk pregnancies. A highly significant inverse linear correlation was observed for fetal distress, admission to neonatal intensive care unit, intrauterine growth retardation, 5-minute Apgar score less than 7, and umbilical cord pH less than 7.20 but not for the incidence of meconium or major anomaly. A highly significant inverse exponential (log 10) relationship was observed for perinatal mortality in total and by component parts and cause. These data strongly suggest the biophysical profile scoring method of fetal risk assessment is accurate and also provides insight into the extent of fetal compromise.

Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios.

Severe oligohydramnios, defined as a condition in which the largest pocket of amniotic fluid measures less than 1 cm in its vertical axis as determined by an ultrasound method, was observed in 113 patients in a population of 15,431 referred high-risk patients (0.7%). In all cases, intervention took place unless there was a recognized structural anomaly or extreme prematurity. Overall gross perinatal mortality was 132.7/1000, and the incidence of major anomaly was 13.3%. With intervention the corrected perinatal mortality rate was 17.7/1000, a rate not significantly different from that observed in the entire population. All end points of perinatal mortality were significantly increased in patients with severe oligohydramnios, in comparison with randomly selected control subjects with normal amniotic fluid. These findings are interpreted to indicate that severe oligohydramnios in a structurally normal fetus is an indication for delivery.

Fetal assessment based on fetal biophysical profile scoring: In 19,221 referred high-risk pregnancies

The incidence of false-negative fetal death, which is defined as stillbirth unrelated to major anomaly or alloimmunization occurring after a last normal fetal biophysical score, was determined in 19,221 referred high-risk pregnancies. The calculated rate of fetal death after a last normal test was 0.72611000 (14 deaths), which remained relatively constant despite a progressive increase in tests and patients studied. We conclude that a normal fetal biophysical profile score confers a high probability of perinatal survival.

Fetal biophysical profile scoring: selective use of the nonstress test.

The fetal biophysical profile score was modified by selective use of the nonstress test. In 2712 study patients (7851 tests) the incidence of nonstress test was reduced to 2.7% with no measurable effect or test accuracy. The nonstress test was most useful in evaluation of abnormal ultrasound monitored variables.

Severe Rh disease—Poor outcome is not inevitable

Most centers report only moderate success in the intrauterine treatment of severe Rh-isoimmune hemolytic disease. For the hydropic fetus, the prognosis is poor. Innovations in the assessment, treatment, and follow-up of the severely affected fetus have yielded more encouraging results. Among the 24 fetuses receiving a refined management plan, instituted in June, 1980, survival rates were 100% in the nonhydropic fetus and 75% in the hydropic fetus. Improved fetal evaluation by means of extensive real-time ultrasonography allows more exact assessment of stage of disease, safer performance of intrauterine transfusion, and a direct picture of the fetal response to treatment. The intrauterine transfusion procedure differs in many aspects from those used in other centers and is notable mostly because of the absence of traumatic fetal death since the present program began. This improvement and the absence of neonatal death have resulted in 92% survival rate among the fetuses transfused. The success of this integrated team approach suggests revision of the pessimism toward the fetus with severe Rh disease.

A Case of Varix Dilatation of the Umbilical Vein and Review of the Literature

Umbilical cord cysts diagnosed antenatally present a challenge to the clinician as they may be associated with adverse perinatal outcomes including abnormal karyotypes and stillbirths. We present a case of an umbilical cord cyst diagnosed by routine ultrasound at 30 weeks of gestation. Findings on sonography included unidirectional movement of echogenic particles suggesting a large varix of the umbilical vein. The patient delivered vaginally at 39 weeks and histopathology confirmed the diagnosis.