Evaluation of the fetal assessment score in pregnancies at risk for intrauterine hypoxia.

OBJECTIVE

Our purpose was to define the diagnostic value of a new fetal assessment score that is based on each of the components of the Apgar score.

STUDY DESIGN

A fetal assessment score was established to study the main fetal vital functions: (1) cardiovascular (heart rate, color of the skin in the Apgar score), now based on fetal heart rate patterns and Doppler assessment of fetal blood flow redistribution, (2) fetal respiratory (quality of breathing in the Apgar score), now based on Doppler assessment of uteroplacental perfusion, and (3) neuromuscular function (tone and reflexes in the Apgar score), now based on fetal tone and response to external stimuli. The fetal assessment score was used in the study of 110 postdate pregnancies and 103 small-for-gestational-age infants and was compared with the traditional biophysical profile score in the prediction of perinatal outcome.

RESULTS

There were significant associations between both the fetal assessment score and the biophysical profile score with fetal distress that necessitated operative delivery, low Apgar scores, and low umbilical cord arterial blood pH. However, receiver-operator characteristic plots demonstrated that the fetal assessment score was superior to the biophysical profile score in predicting fetal distress and low Apgar values particularly in the small-for-gestational-age infants. The best single parameters in predicting fetal distress were the amniotic fluid volume in the biophysical profile score and fetal heart rate patterns and pulsed Doppler measurements in the new score.

CONCLUSION

A fetal Apgar score in which respiration is assessed by placental perfusion rather than chest movements and in which skin color is assessed by centralization of fetal blood flow may be better than the traditional biophysical profile score in predicting fetal hypoxic compromise.