[Evaluation of fetal well-being using a modified Doppler flowmetric profile]

Decreasing perinatal morbimortality rates still represents an essential objective of antenatal care, so better diagnostic test for detecting fetal well-being are needed. The aim of this study was to compare a modified Doppler Ultrasonography Profile (DUP) with the Manning Fetal Biophysical Profile (FBP). One hundred and thirty eight high risk pregnant women between 38 and 42 gestational age, were prospectively studied with the proposed technique. The modified DUP is a quick-easy method that included five variables: umbilical Doppler velocimetry, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. The modified DUP diagnostic accuracy was compared with FBP diagnostic accuracy and a logistical regression analysis was performed to find predictors of fetal well-being. The sensitivity, specificity, and positive and negative predictive values of DUP in predicting perinatal outcome were 28%, 97%, 40% and 96.2%, respectively. On the other hand sensitivity, specificity, and positive and negative predictive values of the FBP were: 20%, 91%, 11% and 95.6%, respectively. The 95% confidence intervals for sensitivity and specificity wore 20.7-25.2 and 94.5-99.4, for the modified DUP whereas were obtained for FBP 12.2-27.7 and 85.6-96.3. The concordance between evaluated tests was 89%, with a Kappa value of 0.80. The multivariate logistical analysis showed two predictor variables as significant in the modified DUP model (umbilical Doppler velocimetry, P < 0.05, and fetal growth pattern, P < 0.05) but in the FBP no parameter reached statistical significance. Although the modified DUP had better diagnostic values an overlapping was clearly found in 95% confidence intervals, therefore it was concluded that the modified DUP proposed had similar diagnostic accuracy as FBP and could be alternatively used for assessing fetal well-being in high-risk pregnancies.