Valor predictivo de la monitorización antenatal de la F.C.F. según la patología y la edad gestacional
ENGLISH ABSTRACT: Predictive value of antenatal fetal heart rate monitoring (AFHRM) related to pathology and gestational age OBJECTIVE: To compare predictive value of AFHRM related to maternal or fetal pathology detected during pregnancy or to gestational age on which monitoring is done. MATERIAL AND METHODS: Perinatal results in 1944 fetuses out of 1928 pregnant women, grouped according to mother or fetal pathology, are retrospectively related with the result of AFHRM the week before delivery in order to evaluate its predictive value. Fifty fetuses are tested prospectively with AFHRM one hour long on a weekly basis from 28 and 34 weeks. Perinatal results of 205 fetuses born between 28 and 36 weeks gestation and 1408 fetuses born between 37 and 41 weeks gestation are also evaluated and related to AFHRM results within a week before delivery. AFHRM criteria of normality are the presence of transient accelerations and the presence of decelerations or a low variability suggests fetal distress. Perinatal morbidity criteria are: Perinatal death, umbilical arterial pH lower than 7.20, or if artery is collapsed an umbilical vein pH lower of 7.25, Apgar index below 7 at five minutes life and/or presence of intrauterine growth retardation and amniotic meconium staining in elective caesarean. Studies of sensitivity, specificity, positive and negative predictive value and comparative analysis by means of Chi-square and exact Fischer test are made for the different groups studied. RESULTS: A good sensitivity and negative predictive value and a low specificity and positive predictive value are observed on all studied groups. Rh isoimmunization, clinical or ecographical suspicion of fetal growth retardation, poor obstetric history, hypertensive diseases, diabetes plus hypertension are pathologies where AFHRM is most useful. AFHRM looks less useful in diabetes without hypertension and in low risk pregnancies because of its low specificity and positive predictive value. AFHRM before term shows a high sensitivity and negative predictive value, with a low specificity and positive predictive value, as long as new interpretative criteria based on gestational age are clearly set.
Advisor:González Merlo, Jesús
School:Universitat de Barcelona
Source Type:Master's Thesis
Keywords:obstetrícia i ginecologia pediatria radiologia medicina física
Date of Publication:07/08/1988