Umbilical artery resistance index as a screening test for fetal well-being. I: Prospective revealed evaluation

Abnormalities of the human fetoplacental circulation, a common association with fetal morbidity and mortality, can be detected by Doppler ultrasound examination of the umbilical arterial blood flow. The value of this procedure as a screening test was assessed in 369 women whose fetuses were evaluated on 1354 occasions using both computerized antenatal fetal heart rate (FHR) analysis and continuouswave Doppler ultrasound. The FHR analyses were used to guide management, but the results of the Doppler measurements were not made available to the clinical staff. The mean duration of each nonstress test (NST) was 27 minutes, compared with 6 minutes for the Doppler examination. Increased resistance indices in the umbilical artery identified those fetuses with an abnormal NST or a clinical diagnosis of antenatal distress with a high sensitivity and negative predictive value. The high rate of false-positive results with respect to these two end points was reduced when fetal distress in labor was included as a third end point. The value of the Doppler examination in predicting fetal distress was applicable to appropriately grown as well as small for gestational age fetuses. © 1991 by The American College of Obstetricians and Gynecologists.