Surveillance of growth-retarded fetuses with computerized fetal heart rate monitoring combined with Doppler velocimetry of the umbilical and uterine arteries.

OBJECTIVE: To define guidelines for surveillance of growth-retarded fetuses with a computerized fetal heart rate (FHR) monitor and Doppler device. STUDY DESIGN: Eighty-one growth-retarded fetuses with birth weights < 10th percentile and lacking major anomalies were studied. One hundred ninety-two tests (one to six per patient), including computerized FHR monitoring and Doppler studies of the umbilical and uterine arteries, were performed. The relationship between Doppler velocimetry or FHR variation and fetal outcome was examined. RESULTS: Fetuses with an abnormal FHR variation or abnormal Doppler velocimetry had a significantly higher rate of cesarean deliveries for fetal distress and a higher number of admissions to the neonatal intensive care unit (NICU) as compared with fetuses with normal results on both tests. The best distinction was noted when the growth-retarded fetuses were partitioned into four analytic groups based on the presence of normal or abnormal FHR variation or Doppler velocimetry. The group with the poorest results was composed of fetuses with abnormal umbilical flow velocity and reduced FHR variation. These fetuses had significantly lower birth weights (1,250 g) and significantly higher rates of cesarean deliveries for fetal distress (92%) and admission to the NICU (100%). Thirty percent of these fetuses died. CONCLUSION: Fetal surveillance with Doppler and computerized FHR monitoring allows better understanding of the management of fetuses that are small for gestational age.