DOES INCREASED RESISTANCE ON UMBILICAL ARTERY DOPPLER PRECLUDE A TRIAL OF LABOR

Objective: To determine whether patients with increased resistance on umbilical artery Doppler velocimetry could be safely allowed a trial o f labour. Design: The Coombe Womens' Hospital is a university teaching hospital which rakes tertiary referrals. All singleton pregnancies fo und to have increased resistance (> 2 SD above the mean for gestationa l age) on umbilical artery Doppler ultrasound between 1993 and 1995 in clusively were identified from the ultrasound database and reviewed, r etrospectively. Cases where the umbilical artery waveform reverted to normal or deteriorated to absent end diastolic flow on a subsequent sc an were excluded. The 118 cases identified were divided into two group s, those that were delivered by elective caesarean section and those t hat laboured. Results: Forty-five patients were delivered by elective caesarean section and 73 were allowed to labour. In the group that lab oured over 90% delivered vaginally and 9.8% were delivered by emergenc y caesarean section. Three babies had a cord pH less than 7.20 in the group that laboured. Two babies had an Apgar score of less than 7 at 5 min in the group that were delivered electively. There were no neonat al seizures or perinatal deaths in either of the two groups. Conclusio n: This study shows that patients with increased resistance on umbilic al artery Doppler can be allowed a trial of labour without compromisin g the fetal outcome. We would suggest that consideration be given to i nduction of labour in selected patients as an alternative to elective section. (C) 1998 Elsevier Science Ireland Ltd.