An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management

Abstract Background The clinical diagnosis of late Fetal Growth Restriction (FGR) involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted computerized cardiotocography (cCTG). The aim of the study was to evaluate the diagnostic power of com...

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Autores principales:	Giuseppina Esposito, Nicolò Pini, Salvatore Tagliaferri, Marta Campanile, Fulvio Zullo, Giovanni Magenes, Giuseppe Maria Maruotti, Maria Gabriella Signorini
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Late fetal growth restriction Doppler ultrasound data Antepartum fetal heart rate monitoring Computerized cardiotocography Phase-rectified signal average Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/59d92484de0b4d678f454bd9fc133c5d
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spelling	oai:doaj.org-article:59d92484de0b4d678f454bd9fc133c5d2021-11-21T12:32:47ZAn integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management10.1186/s12884-021-04235-01471-2393https://doaj.org/article/59d92484de0b4d678f454bd9fc133c5d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12884-021-04235-0https://doaj.org/toc/1471-2393Abstract Background The clinical diagnosis of late Fetal Growth Restriction (FGR) involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted computerized cardiotocography (cCTG). The aim of the study was to evaluate the diagnostic power of combined Doppler and cCTG parameters by contrasting late FGR –and healthy controls. Methods The study was conducted from January 2018 to May 2020. Only pregnant women who had the last Doppler measurement obtained within 1 week before delivery and cCTG performed within 24 h before delivery were included in the study. Two hundred forty-nine pregnant women fulfilling the inclusion criteria were enrolled in the study; 95 were confirmed as late FGR and 154 were included in the control group. Results Among the extracted cCTG parameters, Delta Index, Short Term Variability (STV), Long Term Variability (LTV), Acceleration and Deceleration Phase Rectified Slope (APRS, DPRS) values were lower in the late FGR participants compared to the control group. In the FGR cohort, Delta, STV, APRS, and DPRS were found different when stratifying by MCA_PI (MCA_PI <5th centile or > 5th centile). STV and DPRS were the only parameters to be found different when stratifying by (UA_PI >95th centile or UA_PI <95th centile). Additionally, we measured the predictive power of cCTG parameters toward the identification of associated Doppler measures using figures of merit extracted from ROC curves. The AUC of ROC curves were accurate for STV (0,70), Delta (0,68), APRS (0,65) and DPRS (0,71) when UA_PI values were > 95th centile while, the accuracy attributable to the prediction of MCA_PI was 0.76, 0.77, 0.73, and 0.76 for STV, Delta, APRS, and DPRS, respectively. An association of UA_PI>95th centile and MCA_PI<5th centile with higher risk for NICU admission, was observed, while CPR < 5th centile resulted not associated with any perinatal outcome. Values of STV, Delta, APRS, DPRS were significantly lower for FGR neonates admitted to NICU, compared with the uncomplicated FGR cohort. Conclusions The results of this study show the contribution of advanced cCTG parameters and fetal Doppler to the identification of late FGR and the association of those parameters with the risk for NICU admission. Trial registration Retrospectively registered.Giuseppina EspositoNicolò PiniSalvatore TagliaferriMarta CampanileFulvio ZulloGiovanni MagenesGiuseppe Maria MaruottiMaria Gabriella SignoriniBMCarticleLate fetal growth restrictionDoppler ultrasound dataAntepartum fetal heart rate monitoringComputerized cardiotocographyPhase-rectified signal averageGynecology and obstetricsRG1-991ENBMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Late fetal growth restriction Doppler ultrasound data Antepartum fetal heart rate monitoring Computerized cardiotocography Phase-rectified signal average Gynecology and obstetrics RG1-991
spellingShingle	Late fetal growth restriction Doppler ultrasound data Antepartum fetal heart rate monitoring Computerized cardiotocography Phase-rectified signal average Gynecology and obstetrics RG1-991 Giuseppina Esposito Nicolò Pini Salvatore Tagliaferri Marta Campanile Fulvio Zullo Giovanni Magenes Giuseppe Maria Maruotti Maria Gabriella Signorini An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
description	Abstract Background The clinical diagnosis of late Fetal Growth Restriction (FGR) involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted computerized cardiotocography (cCTG). The aim of the study was to evaluate the diagnostic power of combined Doppler and cCTG parameters by contrasting late FGR –and healthy controls. Methods The study was conducted from January 2018 to May 2020. Only pregnant women who had the last Doppler measurement obtained within 1 week before delivery and cCTG performed within 24 h before delivery were included in the study. Two hundred forty-nine pregnant women fulfilling the inclusion criteria were enrolled in the study; 95 were confirmed as late FGR and 154 were included in the control group. Results Among the extracted cCTG parameters, Delta Index, Short Term Variability (STV), Long Term Variability (LTV), Acceleration and Deceleration Phase Rectified Slope (APRS, DPRS) values were lower in the late FGR participants compared to the control group. In the FGR cohort, Delta, STV, APRS, and DPRS were found different when stratifying by MCA_PI (MCA_PI <5th centile or > 5th centile). STV and DPRS were the only parameters to be found different when stratifying by (UA_PI >95th centile or UA_PI <95th centile). Additionally, we measured the predictive power of cCTG parameters toward the identification of associated Doppler measures using figures of merit extracted from ROC curves. The AUC of ROC curves were accurate for STV (0,70), Delta (0,68), APRS (0,65) and DPRS (0,71) when UA_PI values were > 95th centile while, the accuracy attributable to the prediction of MCA_PI was 0.76, 0.77, 0.73, and 0.76 for STV, Delta, APRS, and DPRS, respectively. An association of UA_PI>95th centile and MCA_PI<5th centile with higher risk for NICU admission, was observed, while CPR < 5th centile resulted not associated with any perinatal outcome. Values of STV, Delta, APRS, DPRS were significantly lower for FGR neonates admitted to NICU, compared with the uncomplicated FGR cohort. Conclusions The results of this study show the contribution of advanced cCTG parameters and fetal Doppler to the identification of late FGR and the association of those parameters with the risk for NICU admission. Trial registration Retrospectively registered.
format	article
author	Giuseppina Esposito Nicolò Pini Salvatore Tagliaferri Marta Campanile Fulvio Zullo Giovanni Magenes Giuseppe Maria Maruotti Maria Gabriella Signorini
author_facet	Giuseppina Esposito Nicolò Pini Salvatore Tagliaferri Marta Campanile Fulvio Zullo Giovanni Magenes Giuseppe Maria Maruotti Maria Gabriella Signorini
author_sort	Giuseppina Esposito
title	An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
title_short	An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
title_full	An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
title_fullStr	An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
title_full_unstemmed	An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management
title_sort	integrated approach based on advanced ctg parameters and doppler measurements for late growth restriction management
publisher	BMC
publishDate	2021
url	https://doaj.org/article/59d92484de0b4d678f454bd9fc133c5d
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An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management

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