EVALUATION OF THE FETAL ASSESSMENT SCORE IN PREGNANCIES AT RISK FOR INTRAUTERINE HYPOXIA

OBJECTIVE: Our purpose was to define the diagnostic value of a new fet al assessment score that is based on each of the components of the Apg ar score. STUDY DESIGN: A fetal assessment score was established to st udy the main fetal vital functions: (1) cardiovascular (heart rate, co lor of the skin in the Apgar score), now based on fetal heart rate pat terns and Doppler assessment of fetal blood flow redistribution, (2) f etal respiratory (quality of breathing in the Apgar score), now based on Doppler assessment of uteroplacental perfusion, and (3) neuromuscul ar function (tone and reflexes in the Apgar score), now based on fetal tone and response to external stimuli. The fetal assessment score was used in the study of 1 10 postdate pregnancies and 103 small-for-gest ational-age infants and was compared with the traditional biophysical profile score in the prediction of perinatal outcome. RESULTS: There w ere significant associations between both the fetal assessment score a nd the biophysical profile score with fetal distress that necessitated operative delivery, low Apgar scores, and low umbilical cord arterial blood pH. However, receiver-operator characteristic plots demonstrate d that the fetal assessment score was superior to the biophysical prof ile score in predicting fetal distress and low Apgar values particular ly in the small-for-gestational-age infants. The best single parameter s in predicting fetal distress were the amniotic fluid volume in the b iophysical profile score and fetal heart rate patterns and pulsed Dopp ler measurements in the new score. CONCLUSION: A fetal Apgar score in which respiration is assessed by placental perfusion rather than chest movements and in which skin color is assessed by centralization of fe tal blood flow may be better than the traditional biophysical profile score in predicting fetal hypoxic compromise.