FETAL CEREBRAL AND UMBILICAL ARTERY BLOOD-FLOW CHANGES DURING PREGNANCY COMPLICATED BY MALARIA

The objectives of our study were to quantify the fetal cerebral artery and umbilical artery blood flow changes daily during a malaria crisis in a pregnant patient and evaluate the sensitivity and the specificit y of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy The study, designed as a prospective and observa tional one, uas carried out in the obstetric department of a governmen t hospital in French Guiana, on 23 women with pregnancies complicated by malaria (age range, 23 +/- 5 years; primiparas, 30%; crisis date: 3 0.8 +/- 2.5 weeks of gestation; start of treatment: 3.7 +/- 1.3 days a fter crisis started). The main measures of outcome consisted of daily determinations of fetal Doppler indices during the crisis, evidence of fetal distress (fetal heart rate decelerations) during labor, Apgar s cores after birth, gestational age at birth, mode of delivery, and bir th weight. During the crisis umbilical artery resistance index increas ed by 5 to 20% (P < 0.05), cerebral artery resistance index decreased by 5 to 20% (P < 0.05), and CURR decreased by 10 to 35% (P < 0.01), in dicating flow redistribution toward the brain. No relationship was fou nd between the CURR value and the following data: parasitemia grade, p arity, gestational age of the crisis, date and mode of delivery, and f etal weight. A change in the hypoxia index (% change in CURR during th e crisis x number of days of crisis) greater than 150 was associated w ith abnormal fetal heart :rate in 75% of the cases, and a hypoxia inde x lower than 150 was associated with normal fetal heart rate in 90% of the cases (sensitivity, 89%; specificity, 77%). Lastly, the combinati on (hypoxia index > 150 and CURR < 1) was associated with abnormal fet al heart rate in 80% of the cases, and one or two of these normal para meters(l) were associated With normal fetal heart rate in 84.6% of the cases (sensitivity, 80%; specificity, 84%). The CURR and the hypoxia index during the malaria crisis can be used to predict acute fetal dis tress at deliver.