R. La Torre, E. Cosmi, M.H. Anceschi, J.J. Piazze, M.Domenica Piga, E.V. Cosmi
Preliminary report on a new and noninvasive method for the assessment of fetal lung maturity
Object: Several patterns of fetal breathing movements
(FBMs), i.e. abdominal wall movements (AWm), thoracic
wall movements (TWm) and nasal fluid flow velocity
waveforms (NFFVW), were investigated by ultrasound
(US) technology and related to fetal pulmonary
maturity and immaturity, i.e. fetal lung maturity (FLM)
tests, in order to validate the hypothesis that they may indicate
whether the fetal lung is mature or immature, regardless
of gender, weight and gestational age.
Material and methods: We prospectively enrolled
143 high-risk pregnancies in which a complete US study
of FBMs and FLM tests was performed. Among them
43 women satisfied the inclusion criteria. US-FLM was
defined as the presence of regular NFFVW detected by
pulsed Doppler and spectral analysis, or irregular NFFVW
synchronous with TWm detected by M-mode. An
US guided amniocentesis was performed in order to collect
amniotic fluid (AF) and FLM was evaluated by L/S
(lecithin/sphingomyelin) determination, presence of
phosphatidylglycerol (PG) and lamellar bodies (LBs)
count. At the end of the study the diagnostic accuracy of
US-FLM was compared to that of FLM tests.
Results: Diagnostic accuracy for US evaluation of FLM
was as follows: sensitivity: 89,6%; specificity: 85,7%;
PPV: 92,8%; NPV: 80%. Diagnostic accuracy of FLM
tests was as follows: sensitivity: 100%;specificity: 51,7%;
PPV: 100%; NPV: 50%. L/S determination predicted
lung maturity with a sensitivity of 100%; specificity of
93,1%; PPV of 100%; NPV of 87,5%.
Conclusion: Presence of regular NFFVW or irregular
NFFVW and TWm correlate accurately with conventional
FLM tests. We suggest that this noninvasive procedure
may be helpful for assessing FLM, particularly
under certain circumstances, e.g., oligo-anhydramnios,
laboratory logistic equipment difficulties or heavily
stained AF samples, amniocentesis refusal, religious
concerns.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 31, 10/2003
Pages: 431 - 434
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