A new biophysical profile

Objective: To study a modification of classical biophysical profile (BP) by the combination of computerized CTG (cCTG) and the evaluation of amniotic fluid index (AFI). Methods: We considered 79 singleton third trimester high-risk pregnancies d elivered by cesarean section, with AFI evaluated within 24 hrs from birth, an antepartum cCTG pet-formed within 6 hrs from delivery, no corticosteroid therapy within 5 days from delivery and a cord blood acid-base status of t he doubled clamped umbilical arterial vessel. We assigned values for AFI (o ligo/anhydramnios=1, normal=0) and cCTG (according to Dawes and Redman crit eria=0, not satisfying Dawes and Redman criteria=1), so two normal tests we re considered score=0, one normal test=1 and both abnormal tests=2. The end point of establishing this score was to evaluate the ability of both tests to predict abnormal, immediate neonatal outcome considering an umbilical ar tery (UA) pH less than or equal to 7.2 and an Apgar score at 5 min less tha n or equal to 7 as abnormal results. Results: When performing a multiple logistic regression for the whole group (No=79), we found that AFI + cCTG score (abnormal value 1-2) was able to s ignificantly predict an UA pH value (less than or equal to 7.20) with an O. R.=5.40 (p<0.001) and an 5 min Apgar score (<less than or equal to> 7) with an O.R.=5.44 (p<0.02). Regarding < 37 wks group (No=31) an altered AFI+cCT G score was able to predict an pH value with an O.R.=5.14 (p=0.03), but not the Apgar score. For greater than or equal to 37 wks group (No=48) AFI+cCT G score was able to predict an altered pH value with an O.R. = 5.9 (p<0.01) . Multiple logistic regression for the prediction of Apgar 5 min score in t his subgroup was not performed since no neonate presented an Apgar score <l ess than or equal to> 7. Comment: We suggest that the combination of cCTG+AFI through the introducti on of a simple score may be useful when a decision should be taken regardin g the timing of delivery in high risk third trimester pregnancies.