Intrapartum Doppler velocimetry, amniotic fluid volume, and fetal heart rate as predictors of subsequent fetal distress. I. An initial report.

This study examines the usefulness of umbilical artery Doppler velocimetry, amniotic fluid volume assessment, and fetal heart rate data in the early intrapartum period as predictors of subsequent fetal distress. A total of 109 patients seen in the latent phase of labor in the labor and delivery area were studied. Both an abnormal initial fetal heart rate and an amniotic fluid index less than or equal to 5.0 cm were associated with a significant increase in the incidence of intrapartum fetal distress. Conversely, a systolic/diastolic ratio greater than 3.0 by Doppler ultrasonography was not associated with increased fetal morbidity. Overall, the sensitivities, specificities, and positive predictive values of the fetal heart rate tracing and the amniotic fluid volume assessment were comparable. Doppler systolic/diastolic ratios showed very poor sensitivity and positive predictive value. We conclude that the fetal heart rate tracing or the assessment of amniotic fluid volume in the early intrapartum period are reasonable predictors of subsequent fetal condition. The lack of patients with the absence of or reverse umbilical velocity preclude conclusions with regard to Doppler systolic/diastolic ratios for this purpose.