SURVEILLANCE OF GROWTH-RETARDED FETUSES WITH COMPUTERIZED FETAL HEART-RATE MONITORING COMBINED WITH DOPPLER VELOCIMETRY OF THE UMBILICAL AND UTERINE ARTERIES

OBJECTIVE: To define guidelines for surveillance of growth-retarded fe tuses with a computerized fetal heart rate (FHR) monitor and Doppler d evice. STUDY DESIGN: Eighty-one growth-retarded fetuses with birth wei ghts <10th percentile and lacking major anomalies were studied. One hu ndred ninety-two tests (one to six per patient), including computerize d FHR monitoring and Doppler studies of the umbilical and uterine arte ries, were performed. The relationship between Doppler velocimetry or FHR variation and fetal outcomes was examined. RESULTS: Fetuses with a n abnormal FHR variation or abnormal Doppler velocimetry had a signifi cantly higher rate of cesarean deliveries for fetal distress and a hig her number of admissions to the neonatal intensive care unit (NICU) as compared with fetuses with normal results on both tests. The best dis tinction was noted when the growth-retarded fetuses were partitioned i nto four analytic groups based on the presence of normal or abnormal F HR variation or DoppIer velocimetry. The group with the poorest result s was composed of fetuses with abnormal umbilical flow velocity and re duced FHR variation. These fetuses had significantly lower birth weigh ts (1,250 g) and significantly higher rates of cesarean deliveries for fetal distress (92%) and admission to the NICU (100%). Thirty percent of these fetuses died. CONCLUSION: Fetal surveillance with Doppler an d computerized FHR monitoring allows better understanding of the manag ement of fetuses that are small for gestational age.