No description available.

Thesis (M.S.)--University of Delaware, 2006. / Principal faculty advisor: Leta P. Aljadir, Dept. of Health, Nutrition and Exercise. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (p. 255-271).

Introduction: An assessment of the role of Doppler ultrasound velocity waveform analysis of the fetal umbilical arteries in the diagnosis of fetal distress in labour is made from a review of the literature and clinical study. Study objectives: 1) To determine the value of screening with Doppler ultrasound in high-risk labours in the prediction of the development of indicators of fetal distress. 2) To determine whether Doppler velocimetry indices of the umbilical arteries change with the development of indicators of fetal distress in labour. Design: Repeated Doppler velocimetry in selected high risk labours. Setting: Groote Schuur Hospital, Cape Town, South Africa, a large tertiary referral centre. Subjects: Thirty six women with singleton pregnancies complicated either by gestational proteinuric hypertension or by intrauterine growth retardation or both with a normal cardiotocographic tracing at the onset of labour. Main outcome measures: 1) Acid-base status of the fetus was assessed after deli very by analysis of umbilical artery blood. 2) Apgar score was recorded at 1 and 5 minutes. 3) Neonates were carefully examined for clinical signs of perinatal hypoxia. Results: Twenty seven fetuses were followed through labour. No relation was found between umbilical artery Pourcelot ratio (resistance index) on admission in labour and umbilical artery base deficit. Six fetuses were born with an umbilical artery base deficit of more than 10 mmol 1-1. Zero change in mean Pourcelot ratio was noted in both normal and acidotic fetuses. None of the acidotic fetuses showed a change in Pourcelot ratio of more than 0.03. The study had an 80% power to detect a change in mean Pourcelot ratio of 0.07 in the normal fetuses and 0.16 in the acidotic fetuses at a 95% confidence level. No relation was found between Pourcelot ratio on admission in labour or change in Pourcelot ratio during labour and Apgar score. None of the neonates showed clinical signs of perinatal hypoxia. Conclusions: Doppler velocimetry of the umbilical arteries in labour as measured by the Pourcelot ratio does not contribute to the diagnosis of fetal distress in labour.

A presente pesquisa teve a finalidade de padronizar a técnica de cardiotocografia a ser utilizada para avaliar a existência de hipóxia/sofrimento fetal durante a vida intrauterina, procurando estabelecer a partir do 7º mês da gestação os padrões de normalidade da frequência cardíaca fetal para fetos sadios e oriundos de inseminação artificial, bem como avaliar a influência da clonagem nos parâmetros obtidos no exame de cardiotocografia. Foram acompanhadas as gestações de 14 vacas, sendo os animais divididos em três grupos experimentais: Grupo de Clones Mortos composto de 5 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados pela técnica de clonagem e nos quais a morte do bezerro ocorreu nas primeiras 36 horas de vida ; Grupo de Clones Vivos composto de 4 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados pela técnica de clonagem e que permaneceram vivos após o nascimento; Grupo Controle - composto de 5 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados por inseminação artificial e que deram origem a bezerros sadios. Os animais foram acompanhados por exames periódicos de cardiotocografia realizados nos seguintes momentos: 90, 60, 30, 15, 7, 6, 5, 4, 3, 2, 1 dia antes do parto e no dia do parto. Para a realização dos exames foi utilizado o aparelho de cardiotocografia da marca Philips modelo Avalon FM30,no local onde as vacas se encontravam. Os exames tiveram uma duração de 20 a 40 minutos de traçado, sendo que o transdutor de ultra-som era acomodado de forma a obter o melhor sinal cardíaco fetal. Imediatamente após o nascimento, realizou-se a avaliação da viabilidade de bezerros recém-nascidos pelo método APGAR e a observação de bezerros tingidos de amarelo em decorrência da presença de mecônio nas secreções uterinas.Através dos traçados obtidos com a cardiotocografia foram analisados os parâmetros da cardiotocografia: linha de base, acelerações transitórias, acelerações prolongadas, variabilidade, taquicardia, bradicardia e desacelerações, sendo ao final calculado o índice cardiotocométrico. Nos animais classificados como hipoativo ou inativo aplicava-se estimulação por palpação retal com beliscamento do espaço interdigital do feto com o objetivo de modificar o comportamento fetal e evitar resultados falso positivos.O exame de cardiotocografia mostrou ser eficaz na avaliação da vitalidade fetal na espécie bovina. Os valores médios e o desvio padrão da frequência cardíaca fetal basal (linha de base) em fetos hígidos foi igual a 116,4 ± 9,07 bpm. Considerou-se taquicardia uma frequência cardíaca fetal igual ou maior do que 145 bpm e bradicardia uma frequência cardíaca igual ou menor do que 90 bpm. Considerou-se normal para bovinos uma variabilidade com valores situados entre 5 e 15 bpm. Verificou-se que a presença de acelerações transitórias são indicativas de bem estar fetal, sendo que o número de acelerações transitórios consideradas como fisiológicas varia entre 1 e 5. Desacelerações são indicativos da existência de sofrimento fetal, não sendo observadas em animais hígidos. No grupo de clones mortos, existem modificações da carditocografia compatíveis com a ocorrência de sofrimento fetal/ hipóxia intrauterina. Os fetos do grupo de clones mortos apresentaram com maior frequência momentos de hipoatividade fetal do que os fetos do grupo de clones vivos e fetos do grupo controle e os fetos do grupo de clone mortos foram classificados com maior frequência como não reativos ao estímulo de beliscamento das extremidades do que os fetos do grupo controle. Os fetos do grupo de clones mortos apresentaram com mais frequência bradicardia (11,8%) do que a observada no grupo controle (0,00 %). Observou-se que no grupo de clones mortos (1,4 ± 1,6) o número de acelerações transitórias foi significativamente menor do que o observado no grupo de clones vivos (3,50 ± 2,70) e no grupo controle (2,70 ± 1,80). / This research had the purpose to standardize the technique of cardiotocography to be used to assess the presence of hypoxia / fetal distress during intrauterine life, trying to establish from the 7th month of pregnancy the normal range of fetal heart rate in healthy fetuses and from artificial insemination and cloning to evaluate the influence of the parameters obtained in the examination of cardiotocography. Were followed the pregnancies of 14 cows and animals are divided into three experimental groups: Dead Clones Group - composed of 5 pregnant cows which was accompanied the cardiotocography of fetuses generated by the technique of cloning, in which the death occurred in the calf first 36 hours of life; Living Clones Group - composed of 4 pregnant cows which is accompanied cardiotocography of fetuses generated by the technique of cloning and remained alive after the birth, control group - composed of 5 pregnant cows in which follow - the cardiotocography of fetuses generated by artificial insemination and gave rise to healthy calves. The animals were monitored by periodic assessment of cardiotocography performed in the following periods: 90, 60, 30, 15, 7, 6, 5, 4, 3, 2, 1 day before parturition and day of birth. For the examinations we used the apparatus of cardiotocography Brand Philips Avalon FM30 model, where the cows were. The tests had a duration of 20 to 40 minutes of track, and the ultrasound transducer was adjusted to obtain the best fetal cardiac signal. Immediately after birth, was held to assess the viability of newborn calves by the method APGAR and the observation of colored yellow calves due to the presence of meconium in the uterine secretions. Through cardiotocography tracings were analyzed with the parameters of cardiotocography : the baseline, acceleration transient, prolonged accelerations, variability, tachycardia, bradycardia, and deceleration modes, and the final calculated the index cardiotocométrico. In the animals classified as inactive or hypoactive stimulation was applied by rectal palpation of the interdigital space with pinch of the fetus with order to modify the behavior and prevent fetal false positives. An examination of cardiotocography has proven effective in evaluation of fetal vitality in the bovine species. The mean values and standard deviation of the baseline fetal heart rate (from baseline) in healthy fetuses was equal to 116.4 ± 9.07 bpm. Tachycardia was considered a fetal heart rate equal to or greater than 145 bpm bradycardia and a heart rate less than or equal to 90 bpm. It was considered normal for cattle variability with values between 5 and 15 bpm. It was found that the presence of transient accelerations are indicative of fetal well-being, and the number of transient accelerations considered physiological ranges between 1 and 5. Deceleration is indicative of the existence of fetal distress and is not observed in healthy animals. In the group of clones dead, there are changes in cardiotocography consistent with the occurrence of fetal distress / intrauterine hypoxia. The fetuses of the group of clones had killed more often moments of fetal hypoactivity than the fetuses of the group of clones live fetuses and the control group and the group of fetuses dead clone were classified more frequently as non-reactive to stimulation of the pinch ends of the fetuses in the control group. The fetuses of the group of dead clones showed bradycardia more often (11.8%) than that observed in the control group (0.00%). It was observed that the group of dead clones (1.4 ± 1.6) the number of transient acceleration was significantly lower than that observed in the group of live clones (3.50 ± 2.70) and the control group (2 , 70 ± 1.80).

Title from title page of PDF (University of Missouri--St. Louis, viewed March 3, 2010). Includes bibliographical references (p. 86-99).

Submitted by (edna.saturno@ufrpe.br) on 2016-07-20T13:38:22Z No. of bitstreams: 1 Debora Monteiro Navarro Marques de Oliveira.pdf: 1171425 bytes, checksum: 51b74fd42ae58771f24380698850c0b6 (MD5) / Made available in DSpace on 2016-07-20T13:38:22Z (GMT). No. of bitstreams: 1 Debora Monteiro Navarro Marques de Oliveira.pdf: 1171425 bytes, checksum: 51b74fd42ae58771f24380698850c0b6 (MD5) Previous issue date: 2013-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The Doppler ultrasound is a tool that enable the study of the hemodynamic aspects of the patients and is widely used in veterinary medicine for the obstetrical evaluation of the maternal-fetal circulations, thus allowing to characterize the blood flow of the fetus and its viability. However, few studies have been conducted to date, involving the evaluation of Doppler index in fetuses of dogs. Therefore, the objective of this study was to determine Doppler parameters of the main vessels of canine fetuses with bradycardia, in pre-parturition period.Were determined resistance (IR) and pulsatility (IP) indices of the umbilical artery (UA), aorta (AO) and the caudal vena cava (VCC), two fetuses of each pregnant bitch, at gestational age between 58 and 60 days. The fetuses were divided into groups: on suffering (n= 27) and without suffering (n= 15), based on bradycardia (< 220 bpm), evaluated by ultrasonography Mode M of the umbilical artery. For statistical analysis were used the Pearson correlation test and analysis of variance (ANOVA), followed by Student T test. In the groups with and without bradycardia was observed significant difference (p < 0,05) between the average of FC, as well as of the parameters IRAU, IPAU, IRVCC showed statistically significant differences. For IPVC was observed a trend (p ≤ 0.09) to be higher in fetuses presenting suffering. High, positive and significant correlations were obtained between IRAU x IPAU, IRAU x IRVCC, IRAU x IPVCC, IPAU x IRVCC, IPAU x IPVCC, IRAA x IPAA, IRVCC x IPVCC, and moderate and positive between IRAA x IPVCC e IPAA x IPVCC. A moderate negative correlation was observed between FC x IRVCC (p < 0.05). Based on this results, were established that values great than, 0,7 (IRAU), 1,6 (IPAU) and 0,7 (IRVCC) characterize suffering fetuses. The definition of these parameters brings important contribution in the routine of clinical obstetrics in relation to the diagnosis of fetal distress, favoring the decision regarding the need to interventions during pregnancy in bitches. / A ultrassonografia Doppler tem possibilitado o estudo sobre os aspectos hemodinâmicos dos pacientes, sendo bastante utilizada na medicina veterinária para a avaliação obstétrica das circulações materno-fetais, permitindo caracterizar a relação do fluxo sanguíneo do feto com a sua viabilidade. No entanto, a avaliação de índices Dopplerfluxométricos para fetos da espécie canina, ainda é pouco estudada. O objetivo deste estudo foi determinar parâmetros Dopplerfluxométricos dos principais vasos de fetos de cães, com bradicardia, no período pré-parto. Foram determinados os índices de resistividade (IR) e de pulsatilidade (IP) da artéria umbilical (AU), artéria aorta (AA) e veia cava caudal (VCC), sendo avaliado o máximo de dois fetos por cadela gestante, com idade gestacional entre de 58 e 60 dias. Os fetos foram divididos em dois grupos com (< 220 bpm) e sem bradicardia, que foi avaliada através da ultrassonografia em Modo M, utilizando as artérias umbilical e aorta, e veia cava caudal. Para a análise estatística foram utilizados teste de correlação de Pearson e análise de variância (ANOVA), seguido de teste T de Student. Nos grupos com e sem bradicardia foi observada diferença significativa (p < 0,05) entre as médias de FC, assim como para os parâmetros IRAU, IPAU, IRVCC. Para o IPVC foi observada uma tendência (p ≤ 0,09) a ser maior nos fetos que apresentavam bradicardia. Obtiveram-se correlações altas, positivas e significativas entre IRAU x IPAU, IRAU x IRVCC, IRAU x IPVCC, IPAU x IRVCC, IPAU x IPVCC, IRAA x IPAA, IRVCC x IPVCC, e moderadas e positivas entre IRAA x IPVCC e IPAA x IPVCC. Uma correlação moderada e negativa foi observada entre FC x IRVCC (p < 0,05). Com base nesses resultados, pode-se estabelecer que o sofrimento fetal, ocorre quando os valores forem maiores que: 0,7 para IRAU, 1,6 para IPAU e 0,7 para IRVCC. A definição destes parâmetros traz importante contribuição na rotina clínico-obstétrica referente ao diagnóstico de sofrimento fetal, favorecendo a tomada de decisões quanto a necessidade de intervenções durante o período gestacional de cadelas.

A presente pesquisa teve a finalidade de padronizar a técnica de cardiotocografia a ser utilizada para avaliar a existência de hipóxia/sofrimento fetal durante a vida intrauterina, procurando estabelecer a partir do 7º mês da gestação os padrões de normalidade da frequência cardíaca fetal para fetos sadios e oriundos de inseminação artificial, bem como avaliar a influência da clonagem nos parâmetros obtidos no exame de cardiotocografia. Foram acompanhadas as gestações de 14 vacas, sendo os animais divididos em três grupos experimentais: Grupo de Clones Mortos composto de 5 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados pela técnica de clonagem e nos quais a morte do bezerro ocorreu nas primeiras 36 horas de vida ; Grupo de Clones Vivos composto de 4 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados pela técnica de clonagem e que permaneceram vivos após o nascimento; Grupo Controle - composto de 5 vacas gestantes nas quais acompanhou-se a carditocografia de fetos gerados por inseminação artificial e que deram origem a bezerros sadios. Os animais foram acompanhados por exames periódicos de cardiotocografia realizados nos seguintes momentos: 90, 60, 30, 15, 7, 6, 5, 4, 3, 2, 1 dia antes do parto e no dia do parto. Para a realização dos exames foi utilizado o aparelho de cardiotocografia da marca Philips modelo Avalon FM30,no local onde as vacas se encontravam. Os exames tiveram uma duração de 20 a 40 minutos de traçado, sendo que o transdutor de ultra-som era acomodado de forma a obter o melhor sinal cardíaco fetal. Imediatamente após o nascimento, realizou-se a avaliação da viabilidade de bezerros recém-nascidos pelo método APGAR e a observação de bezerros tingidos de amarelo em decorrência da presença de mecônio nas secreções uterinas.Através dos traçados obtidos com a cardiotocografia foram analisados os parâmetros da cardiotocografia: linha de base, acelerações transitórias, acelerações prolongadas, variabilidade, taquicardia, bradicardia e desacelerações, sendo ao final calculado o índice cardiotocométrico. Nos animais classificados como hipoativo ou inativo aplicava-se estimulação por palpação retal com beliscamento do espaço interdigital do feto com o objetivo de modificar o comportamento fetal e evitar resultados falso positivos.O exame de cardiotocografia mostrou ser eficaz na avaliação da vitalidade fetal na espécie bovina. Os valores médios e o desvio padrão da frequência cardíaca fetal basal (linha de base) em fetos hígidos foi igual a 116,4 ± 9,07 bpm. Considerou-se taquicardia uma frequência cardíaca fetal igual ou maior do que 145 bpm e bradicardia uma frequência cardíaca igual ou menor do que 90 bpm. Considerou-se normal para bovinos uma variabilidade com valores situados entre 5 e 15 bpm. Verificou-se que a presença de acelerações transitórias são indicativas de bem estar fetal, sendo que o número de acelerações transitórios consideradas como fisiológicas varia entre 1 e 5. Desacelerações são indicativos da existência de sofrimento fetal, não sendo observadas em animais hígidos. No grupo de clones mortos, existem modificações da carditocografia compatíveis com a ocorrência de sofrimento fetal/ hipóxia intrauterina. Os fetos do grupo de clones mortos apresentaram com maior frequência momentos de hipoatividade fetal do que os fetos do grupo de clones vivos e fetos do grupo controle e os fetos do grupo de clone mortos foram classificados com maior frequência como não reativos ao estímulo de beliscamento das extremidades do que os fetos do grupo controle. Os fetos do grupo de clones mortos apresentaram com mais frequência bradicardia (11,8%) do que a observada no grupo controle (0,00 %). Observou-se que no grupo de clones mortos (1,4 ± 1,6) o número de acelerações transitórias foi significativamente menor do que o observado no grupo de clones vivos (3,50 ± 2,70) e no grupo controle (2,70 ± 1,80). / This research had the purpose to standardize the technique of cardiotocography to be used to assess the presence of hypoxia / fetal distress during intrauterine life, trying to establish from the 7th month of pregnancy the normal range of fetal heart rate in healthy fetuses and from artificial insemination and cloning to evaluate the influence of the parameters obtained in the examination of cardiotocography. Were followed the pregnancies of 14 cows and animals are divided into three experimental groups: Dead Clones Group - composed of 5 pregnant cows which was accompanied the cardiotocography of fetuses generated by the technique of cloning, in which the death occurred in the calf first 36 hours of life; Living Clones Group - composed of 4 pregnant cows which is accompanied cardiotocography of fetuses generated by the technique of cloning and remained alive after the birth, control group - composed of 5 pregnant cows in which follow - the cardiotocography of fetuses generated by artificial insemination and gave rise to healthy calves. The animals were monitored by periodic assessment of cardiotocography performed in the following periods: 90, 60, 30, 15, 7, 6, 5, 4, 3, 2, 1 day before parturition and day of birth. For the examinations we used the apparatus of cardiotocography Brand Philips Avalon FM30 model, where the cows were. The tests had a duration of 20 to 40 minutes of track, and the ultrasound transducer was adjusted to obtain the best fetal cardiac signal. Immediately after birth, was held to assess the viability of newborn calves by the method APGAR and the observation of colored yellow calves due to the presence of meconium in the uterine secretions. Through cardiotocography tracings were analyzed with the parameters of cardiotocography : the baseline, acceleration transient, prolonged accelerations, variability, tachycardia, bradycardia, and deceleration modes, and the final calculated the index cardiotocométrico. In the animals classified as inactive or hypoactive stimulation was applied by rectal palpation of the interdigital space with pinch of the fetus with order to modify the behavior and prevent fetal false positives. An examination of cardiotocography has proven effective in evaluation of fetal vitality in the bovine species. The mean values and standard deviation of the baseline fetal heart rate (from baseline) in healthy fetuses was equal to 116.4 ± 9.07 bpm. Tachycardia was considered a fetal heart rate equal to or greater than 145 bpm bradycardia and a heart rate less than or equal to 90 bpm. It was considered normal for cattle variability with values between 5 and 15 bpm. It was found that the presence of transient accelerations are indicative of fetal well-being, and the number of transient accelerations considered physiological ranges between 1 and 5. Deceleration is indicative of the existence of fetal distress and is not observed in healthy animals. In the group of clones dead, there are changes in cardiotocography consistent with the occurrence of fetal distress / intrauterine hypoxia. The fetuses of the group of clones had killed more often moments of fetal hypoactivity than the fetuses of the group of clones live fetuses and the control group and the group of fetuses dead clone were classified more frequently as non-reactive to stimulation of the pinch ends of the fetuses in the control group. The fetuses of the group of dead clones showed bradycardia more often (11.8%) than that observed in the control group (0.00%). It was observed that the group of dead clones (1.4 ± 1.6) the number of transient acceleration was significantly lower than that observed in the group of live clones (3.50 ± 2.70) and the control group (2 , 70 ± 1.80).

A sharp increase in caesarean section (CS) rates at the Muhimbili National Referral Hospital (MNH) – a tertiary referral hospital in Tanzania – by 50% in 2000–2011, was associated with concomitant increase in maternal complications and deaths and inconsistent improvement in newborn outcomes. The aims of this thesis were to explore care providers’ in-depth perspective of the reasons for these high rates of CS, and to evaluate and improve standards of care for the most common indica-tions of CS, obstructed labour and fetal distress, which are also major causes of adverse maternal and neonatal outcomes. This thesis reports an investigation performed at MNH, Tanzania. For Paper I, qualitative methods were employed and demonstrated how care providers dismissed their responsibility for the rising CS rate; and, instead, projected the causes onto factors beyond their control. Additionally, dysfunctinal teamwork, transparency, and previous poorly conducted clinical audits led to fear of blame among care providers in cases of poor outcome that subsequently encougared defensive practise by assigning unnecessary CS. Papers II and III evaluated stand-ards of care using a criteria-based audit (CBA) of obstructed labour and fetal dis-tress. After implementing audit-feedback recommendations, the standards of diag-nosis of fetal distress improved by 16% and obstructed labour by 7%. Similarly, the standards of management preceding CS improved tenfold for fetal distress and doubled for obstructed labour. The impact of the CBA process was evaluated by comparing the maternal and perinatal outcomes categorized into Robson groups (Paper IV) of all deliveries occurring before and after the audit process (n=27,960). After the CBA process, there was a 50% risk reduction of severe perinatal morbidi-ty/mortality for patients with obstructed labour. The overall CS rates increased by 10%, and this was attributed to an increase in the CS rate among breech, term preg-nancies (Robson group 6), and preterm pregnancies (Robson group 10) that specifi-cally had reduced risk of poor perinatal outcome. The overall neonatal distress rates were also reduced by 20%, and this was attributed to a decrease in the neonatal distress rate among low-risk, term pregnancies (Robson group 3). Importantly, the increased rates of poor perinatal outcomes were associated with referred patients that had higher risk of neonatal distress and PMR than non–referred patients, after CBA process.  In conclusion, the studies managed to educate the care providers to take on their roles as decision-makers and medical experts to minimize unnecessary CS, using the available resources. Care providers’ commitment to achieve the best practice should be sustained and effort for stepwise upgrading quality of obstetric care should be supported by the hospital management from the primary to tertiary referral level.

No setor de Vitalidade Fetal na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foi conduzido estudo caso-controle com seguimento prospectivo com quarenta e seis pacientes. O objetivo desse estudo foi identificar a associação dos testes de avaliação de vitalidade fetal e acidemia ao nascimento em gestações acometidas com dopplervelocimetria anormal e fluxo diastólico positivo das artérias umbilicais. Da mesma maneira, objetivou-se avaliar a relação entre os resultados antenatais, do parto, e neonatais com a ocorrência de pH fetal inferior a 7,20. A evolução para fluxo diastólico ausente ou reverso durante o seguimento foi critério de exclusão. Os casos foram classificados em dois grupos de acordo com a presença (grupo 1), ou ausência (grupo 2) de acidemia ao nascimento (pH inferior a 7,20), por meio da gasometria arterial de cordão imediatamente após o parto. As seguintes variáveis foram submetidas à análise univariada, comparando-se os grupos 1 e 2: idade materna, síndrome hipertensiva, uso de corticóde antenatal para maturação pulmonar, idade gestacional no momento do parto e testes de avaliação de vitalidade fetal do dia do parto. As modalidades dopplervelocimétricas analisadas foram: índice de pulsatilidade do território arterial (representado pela artéria umbilical e artéria cerebral média) e venoso (índice de pulsatilidade para veias do ducto venoso). Os seguintes parâmetros das atividades biofísicas fetais foram estudados: cardiotocografia (normal e anormal), presença de desaceleração tardia, presença de desaceleração (desaceleração tardia, ou desaceleração variável de mau prognóstico, ou desaceleração prolongada), ausência ou não de movimentos respiratórios, presença ou não de oligoâmnio e classificação do escore do perfil biofísico fetal (normal quando maior que 6, e anormal quando menor ou igual a 6). As variáveis clinicamente relevantes e estatisticamente significativas foram analisadas pela regressão logística. A série compôs-se de 46 pacientes classificadas nos grupos 1 (24 casos) e 2 (22 casos) e as seguintes variáveis foram estatisticamente relacionadas à ocorrência de acidemia no nascimento (p0,05): idade materna, síndrome hipertensiva, cardiotocografia anormal, presença de desaceleração, e ausência de movimentos respiratórios. Na regressão logística, a presença de desaceleração foi preditora de acidemia (p=0,024; OR=8,2; IC95%=1,2-52). Os presentes achados sustentam que a presença de acidemia ao nascimento em fetos com dopplevelocimetria anormal e fluxo diastólico positivo das AU está associada principalmente à anormalidade nos parâmetros agudos da avaliação da vitalidade fetal. A presença de desaceleração no traçado cardiotocográfico foi preditora de acidemia ao nascimento. / A longitudinal prospective study was conducted on 46 pregnancies with umbilical artery abnormal pulsatility index and positive diastolic flow velocity. Patients were evaluated at the Fetal Surveillance Unit/ Obstetrics Clinics of the University of São Paulo Medical School General Hospital (HCFMUSP) between February 2007 and March 2009. The objective of this study was to identify a potential association between fetal antenatal surveillance tests and acidemia at birth, in pregnancies with umbilical artery abnormal Doppler velocimetry and positive diastolic flow. In the same context, this research aimed to establish the correlation of data of birth, and neonatal outcome with umbilical cord pH below 7,20. The development of reversed or absent end- diastolic flow velovity in the umbilical artery was an excluision criteria. The cases were divided in two groups, according to the presence (Group 1) or absence (Group 2) of acidemia at birth (pH below 7.20), based on umbilical cord blood gas measurement immediately after birth. The following variables were submitted to univariate analysis comparing Groups 1 and 2: maternal age, hypertensive syndrome, corticosteroid use (for lung maturation), gestational age at birth, and fetal vitality assessments on the day of delivery. The Doppler parameters analysed were: pulsatility index of the umbilical artery, middle cerebral artery and the pulsatility index for veins for the ductus venosus. The following variables of the fetal biophysical profile were obtained: cardiotocography or nonstress test ( normal/ abnormal), presence of late deceleration, presence of deceleration (late or severe variable decelerations, or prolonged bradycardia), absence of fetal breathing movements, presence of oligohydramnios and biophysical profile score (considered normal when the score was higher than 6). Clinically relevant and statistically significant variables were analyzed by logistic regression. The series included 46 patients divided in Group 1 (n=24 with acidosis) and Group 2 (n=22 without acidosis), and the following variables were statistically correlated to acidemia at birth (p0.05): maternal age, hypertensive syndrome, abnormal cardiotocographic findings, deceleration (late deceleration, or variable deceleration with poor prognosis, or prolonged deceleration), and absence of respiratory movements. On logistic regression, the presence of deceleration was predictive of acidemia (p=0,024; OR=8,2; CI95%=1,2-52). In conclusion, we believe that the presence of acidemia at birth in fetuses with umbilical artery positive diastolic flow and abnormal Doppler velocimetry is mainly associated with abnormality of acute parameters of fetal well-being. The finding of deceleration on cardiotocographic assessments was predictive of acidemia at birth. ____________________