The predictive value of fetal middle cerebral artery/descending aorta ratio doppler parameter in the evaluation of perinatal results of intrauterine growth restriction
DOI:
https://doi.org/10.15584/ejcem.2020.4.2Keywords:
fetal MCA/DA Doppler parameters, IUGR, perinatal outcomesAbstract
Introduction. Although there are various reasons for intrauterine growth restriction (IUGR), the main cause is inadequate utero-placental and feto-placental circulation.
Aim. To determine the predictive values of fetal middle cerebral artery/descending aorta (MCA/DA) Doppler parameter in the evaluation of perinatal outcomes in pregnancies with IUGR.
Material and methods. 15 with IUGR and 35 normal newborn, who were born at the 34th gestational week or over included into the study. Doppler ultrasonography (US) measurements were performed. The ratio of pulsatility index/resistive index (PI/ RI) from MCA, umbilical artery (Umb), DA was determined. Neonatal characteristics such as Apgar scores, neonatal intensive care unit (NICU) requirement, weight and sex were also recorded.
Results. In the IUGR group, mean MCA/DA RI-PI, MCA/UmB RI-PI were 0.88±0.19, 0.86±0.28, 1.22±0.18 and 1.55±0.39, respectively. In the control group, mean MCA/DA RI-PI, MCA/UmB RI-PI were 1.15±0.13, 1.09±0.41, 1.37±0.35 and 1.82±0.44, respectively. There were statistically significant relationship between MCA/DA PI with cord blood pH value and NICU requirement, age with gravida, parity, MCA/UmB RI, MCA/UmB PI; gravida with age and parity; parity with age, gravida, weight, MCA/DA RI, PI ratios.
Conclusion. Intrauterine MCA and DA Doppler US parameters of IUGR can be used safely in predicting perinatal outcomes in pregnancies with IUGR over 34 weeks.
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McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortalitiy among newborn infants. N Engl J Med. 1999;340:1234‒1238.
Cunningham FG, Gant NF, Leveno KJ, Gilstrap III LC, Hauth JC, Wenstrom KD. Fetal Growth Disorders. In: Williams Birth Information Volume 1. Akman AC (Translated).21. Printing. İstanbul: Nobel Medical Bookstores. 2005;29:744‒764.
Moll W, Kunzel W, Herberger J. The hemodynamic implications of hemochorial placentation. Eur J Obstet Gynecol Reprod Biol. 1975;5:67‒71.
Jauniaux E, Jurkovic D, Campbell S. In vivo investigation of the anatomy and physiology of early human placental circulations. Ultrasound Obstet Gynecol. 1991;1:435‒445.
Baschat AA, Guclu S, Kush ML, et al. Venous Doppler in the prediction of acid base status of growth restricted fetuses with elevated placental blood flow waveform. Am J Obstet Gynecol. 2004;191:277‒284.
Baschat AA. Arterial and venous Doppler in the diagnosis and management of early onset fetal growth restriction: Review. Early Human Development 2005;81:877‒887.
Simon NV, Surosky BA, Shearer DM, Levisky JS. Effects of the pretest probability of intrauterine growth restriction on the predictiveness of sonographic estimated fetal weight in detecting IUGR: A clinical application of Bayes’ theorem. J Clin Ultrasound 1990;18:145‒153.
Lam H, Leung WC, Lee CP, Lao TT. Relationship between cerebroplacental Doppler ratio and birth weight in postdates pregnancies. Ultrasound Obstet Gynecol. 2005;25:265‒269.
Baschat AA. Integrated fetal testing in growth restriction: combining multivessel Doppler and biophysical parameters. Ultrasound Obstet Gynecol. 2003;21:1‒8.
Oosterhof H, Wichers G, Fidler V, Aarnoudse JG. Blood viscosity and uterine artery flow velocity waveforms in pregnancy: a longitudinal study. Placenta. 1993;14:555‒561.
Baschat AA. Fetal responses to placental insufficiency: an update. BJOG. 2004;111:1031‒1041.
Harman CR, Baschat AA. Comprehensive assessment of fetal wellbeing: which Doppler tests should be performed? Curr Opin Obstet Gynecol. 2003;15:147‒157.
Chaiworapongsa T, Espinoza J, Yoshimatsu JJ, et al. Subclinical myokardial injury in small‒forgestational‒age neonates. J Matern Fetal Neonatal Med. 2002;11:385‒390.
Sau A, El‒Matary A, Newton L, Wickramarachchi DC. Management of red cell alloimmunized pregnancies using conventional methods compared with that of middle cerebral artery peak systolic velocity. Acta Obstet Gynecol Scand. 2009;88:475‒478.
Piazze JJ, Anceschi MM, Picone G, Cerekja A, La Torre R, Cosmi EV. Association between maternal‒fetal Doppler velocimetry and fetal lung maturity. J Perinat Med. 2003;31:484‒488.
Arabin B, Siebert M, Jimenez E,Saling E. Obstetrical characteristics of a loss of end diastolic velocities in the fetal aorta and/or umblical artery using Doppler ultrasound. Gynecol Obstet Invest. 1988;25;173‒180.
Reeves S, Galan HL. Fetal growth restriction. In: Berghella V, editor. Maternal‒fetal evidence based guidelines. 2nd ed. London: Informa Health Care; 2012:329‒344.
Baschat AA, Galan HL, Gabbe SG. Intrauterine growth restriction. In: Gabbe SG, Neibyl JR, Simpson JL, editors. Obstetrics normal and problem pregnancies. Philadelphia: Elsevier; 2012:706–741.
Gagnon R, Van de Hof M. The use of fetal Doppler in obstetrics. J Obstet Gynecol Can. 2003;25:601‒607.
Myatt DP, Wallace C. Endogenous Information Acquisition in Coordination Games. The Review of Economic Studies. 2012;79(1):340‒374.
Aldous MB, Edmonson MB. Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington State. JAMA. 1993;270:2574‒2575.
Strobino DM, Ensminger ME, Kim YJ, Nanda J. Mechanisms for maternal age differences in birth weight. Am J Epidemiol. 1995;142:504‒514.
Berghella V. Prevention of recurrent fetal growth restriction. Obstet Gynecol. 2007;110:904‒912.
Mari G, Hanif F, Kruger M, et al. Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth‒restricted fetuses. Ultrasound Obstet Gynecol. 2007;29:310‒316.
Cruz‒Martinez R, Figueras F, Hernandez‒Andrade E, Oros D, Gratacos E. Fetal Brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small‒for‒gestational‒age fetuses. Obstet Gynecol. 2011;117:618‒626.
Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in high‒risk pregnancies. Cochrane Database Syst Rev. 2010;1:CD007529.
Trudinger BJ. Obstetric doppler applications İn: Fleischer AC, Romero R, Manning FA, et al. The Principles and Practice of Ultrasonography in obstetrics and Gynecology, Appleton and lange, Fourth ed. 1991:12:173.
Ferrazzi E, Bozzo M, Rigano S, et al. Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth‒restricted fetus. Ultrasound Obstet Gynecol. 2002;19:140‒146.
Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol. 2001;18:571‒577.
Seyam YS, Al‒Mahmeid MS, Al‒Tamimi HK. Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Gynaecol Obstet. 2002;77(2):131‒137.
Yoon BH, Romero R, Roh CR, et al. Relationship between the fetal biophysical profile score, umbilical artery Doppler velocimetry, and fetal blood acid‒base status determined by cordocentesis. Am J Obstet Gynecol. 1993;169:1586‒1594.
Vintzileos AM, Lodeiro JG, Feinstein SJ, et al. Value of fetal ponderal index in predicting growth restriction. Obstet Gynecol. 1986;67:584‒588.
Figueras F, Gardosi J. Should we customize fetal growth standards. Fetal Diagn Ther. 2009;25:297‒303.
Martin AM, Bindra R, Curcio P, et al. Screening for preeclampsia and fetal growth restriction by uterine artery Doppler at 11‒14 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18:583‒586.
Cnossen JS, Morris RK, ter Riet G, et al. Use of uterine artery Doppler ultrasonography to predict pre‒eclampsia and intrauterine growth restriction: a systematic review and bivariable meta‒analysis. CMAJ. 2008;178:701‒708.
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