Abdominal circumference: a single measurement versus growth rate in the prediction of intrapartum Cesarean section for fetal distress.

Abstract

The fetal abdominal circumference is the most sensitive ultrasound biometric measurement for predicting intrauterine growth restriction, which is associated with an increased risk of intrapartum fetal distress. We sought to evaluate and compare whether a third-trimester ultrasound measurement of abdominal circumference made within 1 week prior to delivery better predicts operative delivery for fetal distress when compared with the growth velocity of the abdominal circumference in the third trimester. Retrospective analysis was carried out of prospectively collected ultrasound data on 117 patients with singleton gestations who had had at least two ultrasound assessments performed less than 6 weeks apart in the third trimester, with the last ultrasound performed within 1 week prior to delivery. The abdominal circumference value of the last ultrasound prior to delivery was placed into one of three categories: < or = 5% centile, > 5 to < or = 10% centile and > 10% centile for gestational age. The growth velocity of the abdominal circumference per week was placed into one of three categories: < or = 5 mm/week, 6-10 mm/week and > or = 11 mm/week. The chi-squared test was used to compare differences between the incidence of fetal distress between the groups. The incidences of Cesarean section for fetal distress in relation to a single measurement of the abdominal circumference were: < or = 5% centile, 8/23 (35%); > 5 to < or = 10% centile, 3/12 (25%); > 10% centile, 8/81 (10%) ( P < 0.05). The incidences of Cesarean section for fetal distress with the three abdominal circumference growth velocities were: < or = 5 mm/week, 9/55 (16%); 6-10 mm/week, 4/11 (36%); > or = 11 mm/week, 8/51 (16%) ( P = 0.9401). A single measure of the fetal abdominal circumference made within 1 week prior to delivery is superior to an assessment of growth rate of the fetal abdomen in the third trimester in discriminating patients who require Cesarean section for fetal distress.