Doppler Findings in the Fetal Cerebral Blood Vessels (VA/MCA) Within 24 Hours Before Delivery and Relation With Perinatal Outcome.

Study Overview
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Brief Summary
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Assess differences in flow patterns in the fetal cerebral blood vessels within 24 hours before delivery between fetuses with a normal vs. adverse perinatal outcome. Explore maternal and/or fetal characteristics that might influence technical feasibility of doppler sonography of the fetal cerebral blood vessels in early labor at term. Assess reliability of the technique by measuring intra- and inter-observer variation in a subset of participants.

Official Title
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Doppler Findings in the Fetal Cerebral Blood Vessels (VA/MCA) Within 24 Hours Before Delivery and Relation With Perinatal Outcome.

Conditions
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Ultrasonography, Doppler, Obstetric Labor Complications

Intervention / Treatment
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* Other: Ultrasound examination in early labor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Singleton pregnancy. Term gestation (37-42 weeks). Fetus in cephalic presentation. No known fetal chromosomal or (severe) congenital anomaly. Normally grown fetus (ultrasound scan demonstrating normal fetal growth between 30-37 weeks of gestation, defined as an estimated fetal weight/abdominal circumference > 10th centile or crossing <2 quartiles compared to earlier growth ultrasound). Absence of pre-existing doppler or amniotic fluid abnormalities. Normal fetal heart rate tracing / CTG (excluding pre-existing hypoxia). Admission in early spontaneous labor or induction of labor with expected delivery < 24 hours. Maternal age >= 18 years Willing to give written informed consent. Exclusion Criteria: Advanced labor (> 4cm of cervical dilatation) at the time of admission on the labor ward. Severe pre-existing chronic maternal medical condition or poor obstetric history/antenatal complications associated with increased risk of adverse perinatal outcome (non-exhaustive e.g.: uncontrolled chronic hypertension, severe pre-eclampsia, uncontrolled (gestational) diabetes, maternal sepsis, major antepartum haemorrhage, intra-uterine infection, prolonged rupture of membranes > 18 hours, etc.). Intra-uterine fetal demise / death. Prelabour rupture of membranes with meconium-stained amniotic fluid. Patients not fulfilling all the inclusion criteria or refusing to give written informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Term gestation<br> | Other: Ultrasound examination in early labor<br>* Combined trans-abdominal and trans-perineal ultrasound examination<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences in VPR (Vertebro-Placental Ratio) between fetuses/neonates with a composite perinatal outcome score < 3 / => 3 |  | VPR measured in early labor (=< 4cm of cervical dilatation) - perinatal outcome score assessed at delivery - timespan between both observations variable, expected <12 hours. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences in other doppler parameters (PI VA, PI MCA, CPR) between fetuses/neonates with a composite perinatal outcome score < 3 / => 3. |  | VPR measured in early labor (=< 4cm of cervical dilatation) - perinatal outcome score assessed at delivery - timespan between both observations variable, expected <12 hours. | 
| Differences in maternal and fetal characteristics between successful and unsuccessful doppler examinations (observations) of the fetal VA and MCA respectively. |  | Assessed in early labor (=< 4cm of cervical dilatation) |