Exact(8)
Although the overall size of the reduction in birth weight may be seen as small, an extra 60-70 g in weight could reduce perinatal morbidity and mortality in an already compromised fetus.
Whether early delivery at any gestation can save a compromised fetus depends on the gestational age of the fetus, the degree of compromise and the technologic package available for effecting early delivery and caring for the newborn.
Electronic monitoring of the fetal heart rate during labor (EFM), originally designed to assess fetal stress and allow the early detection of the compromised fetus, has instead led to increasing maternal morbidity without decreasing fetal morbidity.
It is now possible to identify UCA on ultrasound and test for the compromised fetus.
Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.
Antenatal fetal surveillance studies are widely used to assess fetal well-being and to identify the compromised fetus.
Similar(52)
Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses.
With IUGR in particular, the expectation is that, all other things being equal, the duration of the CTI will be shorter in compromised fetuses.
Early delivery is thus viewed as a therapeutic package which subsumes antenatal monitoring, diagnosis of fetal well-being, supportive neonatal care and other interventions that permit higher rates of early delivery to rescue compromised fetuses from a hostile intrauterine environment.
This would lead to a discounting of the perinatal mortality reductions that are a consequence of recent changes in the management of compromised fetuses at preterm gestation [ 1, 4, 7- 9, 21- 23].
Uterine artery Doppler waveform analysis accurately identifies compromised fetuses at risk of stillbirth, especially in cases of placental underperfusion associated with pre-eclampsia and/or growth restriction, but no studies have shown any ability of subsequent intervention to prevent stillbirth.
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