Middle cerebral artery peak systolic velocity and ductus venosus reversed flow in the prediction of acid-base status of IUGR fetuses delivered at 30 weeks gestation (original) (raw)
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Journal of Clinical Ultrasound, 2014
Background. To evaluate the role of umbilical artery (UA) peak systolic velocity (PSV) measurements in the prediction of perinatal outcome in fetuses with intrauterine growth restriction (IUGR). Methods. A prospective study was performed, including patients with a suspected diagnosis of IUGR. Exclusion criteria were multiple gestations, unreliable gestational age, and known fetal malformations. Doppler measurements of the UA and middle cerebral artery (MCA) were recorded. Results. Seventy-two patients were enrolled and a total of 192 Doppler measurements were performed between 24 and 39 weeks' gestation. Mean gestational age at delivery was 36.9 6 2.7 days and mean birth weight was 2,166 6 497 grams. Nine patients (12.5%) had oligohydramnios; 50 (69.4%) delivered preterm (<37 weeks), and 26 underwent a cesarean section, of those 7 (29.2%) cesarean sections were for a nonreassuring fetal heart rate tracing. Fifty-one (70.8%) neonates were actually small for gestational age. No correlation was found between UA-PSV and MCA-PSV to perinatal outcome. Correlation was found between UA pulsatility index and cerebroplacental ratio to perinatal outcome before 34 weeks' gestation. Conclusions. UA PSV measurements do not correlate with adverse perinatal outcome. A correlation exists between UA pulsatility index and cerebroplacental ratio and perinatal outcome prior to 34 weeks' gestation. It seems that UA PSV and MCA PSV do not contribute to the management of fetuses with IUGR.
Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story
Ultrasound in Obstetrics and Gynecology, 2005
K E Y W O R D S: biophysical profile; middle cerebral artery; peak systolic velocity; pulsatility index ABSTRACT Objective The aims of this study were to determine if there is a relationship between middle cerebral artery (MCA) peak systolic velocity (PSV) and perinatal mortality in preterm intrauterine growth-restricted (IUGR) fetuses, to compare the performance of MCA pulsatility index (PI), MCA-PSV and umbilical artery (UA) absent/reversed end-diastolic velocity (ARED) in predicting perinatal mortality, to determine the longitudinal changes that occur in MCA-PI and MCA-PSV in these fetuses, and to test the hypothesis that MCA-PSV can provide additional information on the prognosis of hypoxemic IUGR fetuses.
Correlation of fetal middle cerebral artery Doppler indices in IUGR pregnancies
International Journal of Biomedical Research, 2014
Doppler velocimetry studies of placental and fetal circulation can provide important information regarding fetal well being providing an opportunity to improve fetal outcome. The present study was undertaken to evaluate the role of fetal middle cerebral artery blood velocity waveforms, Systolic/Diastolic ratio (S/D), Pulsatility Index (PI), Resistance Index (RI) as predictor of perinatal o utcome in intrauterine growth restriction (IUGR) pregnancies in II nd and III rd trimester. Methods: In the study group, 50 cases of IUGR were studied in II nd and III rd trimester. They were first subjected to ultrasonography biometry and then middle cerebral artery Doppler sonography. Results: In both control and study group the values of S/D ratio, PI and RI in middle cerebral artery decline during II nd to III rd trimester. The values were lower in the study group as compared to the control group. Thus the present study predicts that; a) Lower PI values were suggestive of fetal hypoxia. b) The lower values are due to vasodilatation due to hypoxia in order to supply more blood to the brain to protect it from the damaging effects of hypoxia. Thus the brain is spared from damage. Interpretation and conclusion: Doppler can be considered as one of the important non invasive technique to assess the fetomaternal and uteroplacental circulations. The middle cerebral artery indices were valuable for predicting the outcome of IUGR pregnancies.
Acta Obstetricia et Gynecologica Scandinavica, 1996
Objective. To define the accuracy of the umbilical artery Doppler flow velocity waveforms, according to different cut-off values, in predicting adverse perinatal outcomes among fetuses at high risk of hypoxic complications. Subjects. Two hundred and sixty-five pregnant women with diagnosis of small for gestational age fetus and/or pregnancy induced hypertension studied in four Italian ultrasound units. Methods. Prospective study. Serial Doppler ultrasound measurements of the umbilical artery were performed. Results were not available for clinical management. Cut-off curves, corresponding to different age-specific centiles of the pulsatility index distribution among pregnancies resulting in healthy newborns, regardless of birthweight, were computed by regression methods. Sensitivity, specificity, positive predictive value and negative predictive value of such cut-off curves, and of absentireverse end-diastolic flow, in predicting different adverse outcomes were estimated. The adverse outcomes were: perinatal or neonatal death (OUTCOME I). Death or Apgar<7 at 5' or need for admission to intensive care unit or other hypoxic related abnormalities (OUTCOME 2). Either OUTCOME 2 or birthweight< 10th centile (OUTCOME 3). Both OUTCOME 2 and birthweight< 10th centile (OUTCOME 4). Results. The best accuracy was in predicting OUTCOMES I and 4. Positive predictive value increased strongly with higher cut-off curves while negative predictive value only decreased slightly. For absentireverse end-diastolic flow, negative predictive value and positive predictive value were respectively 94"/0 and 39% for death, and 81% and 72% respectively for OUT-COME 2. For the 95th centile curve the corresponding figures were 96% 33%) and 84% 67%. The 60th centile curve had a 85% and 74%) sensitivity value for death and OUTCOME 2 respectively, but the corresponding positive predictive values were 18% and 40% only. Conclusions. The findings of an absent end diastolic flow or of pulsatility index values above the 95th centile curve strongly suggest it is time to deliver the fetus. The 60th centile curve is the most suitable to recognize fetuses at risk for abnormal outcome, but early delivery should be avoided because of its low positive predictive value.
Middle cerebral artery Doppler indices better predictor for fetal outcome in IUGR
The Journal of Obstetrics and Gynecology of India, 2011
Objective(s) : To compare the role of middle cerebral artery and umbilical artery Doppler pulsatility indices in predicting the fetal outcome in intrauterine growth restriction. Method(s) : The prospective study was conducted on 121 subjects. They were divided into two groups. The study group (n=71) consists of high risk group of pregnant women with growth restricted fetuses. The control group (n=50) consists of pregnant women with healthy fetuses. Both the groups were evaluated by middle cerebral artery and umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Results : Mothers with abnormal velocimetry had more number of cesarean sections to prevent fetal distress than those with normal velocimetry. The subjects with high risk factors had more number of abnormal waveforms than those without high risk factors. The predictive value of Doppler P.I for detecting abnormal fetal outcome was 94% in middle cerebral artery as against 83% for umbilical artery. The sensitivity was 71% for middle cerebral artery versus 44% for umbilical artery. Conclusion : Growth restricted fetuses with normal flow velocimetry are at a lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower as compared to that of neonates with normal velocimetry. Thus middle cerebral artery doppler indices were a better predictor for fetal outcome in IUGR when compared with umbilical artery in terms of sensitivity and predictive value.
Al-Azhar Medical Journal, 2016
Background: Although the increased fetal morbidity and mortality associated with post-term pregnancy has long been appreciated, most authors have studied gestational age as the alone contributing factor. The influence of other factors such as maternal age, parity, maternal smoking, fetal genders, birth weight and past history of post-term has not been adequately evaluated, Additionally, the accuracy of earlier studies is limited by the fact that they predate the widespread use of both ultrasonography for accurate gestational dating and intensive fetal testing to establish fetal wellbeing. Objective: the present study was conducted to evaluate the effects of prolonged exceeding 287 days of menstrual age on the Doppler flow velocity waveforms in the umbilical, middle cerebral and uterine arteries, and its impact on neonatal outcome to determine the best predictor of adverse outcome in post-term. Patients and Methods: The present study included 50 pregnant ladies All patients were submitted to ultrasound for detection of fetal genders, fetal weight and amniotic fluid index (AFI) Also, they were submitted to color Doppler velocimetery of fetoplacental and fetal vessels including middle cerebral pulsitility index MCA PI), umbilical artery pulsitility index UA PI), middle cerebral resistance index MCA RI), umbilical artery resistance index UA RI), uterine artery pulsitility index UtA PI),and uterine artery pulsitility index UtA RI). Results: In the present study, there was no statistical signification with gestational age, fetal heart rate and parity. The primary gravida had the highest incidence. There was higher rate of CS which was significant with prolongation of pregnancy, but with no statistically significant difference between adverse and normal outcome Also, the incidence of males was more than females in our population with no significant relation between fetal gender and neonatal outcome. Adverse outcome was associated with lower MCA PI, MCA RI, AFI, Apgar score, and higher UA RI compared to normal outcome with statistically significant difference between them, but there was no statistically significant difference as regard UA PI, UtA PI, UtA RI. Conclusion: The perinatal morbidity and mortality may be increase in post-term pregnancies. However, the all screening tests and Doppler indices may be normal due to mode of delivery, time of delivery, and type of anesthesia during labor. So, during labor, rapid interference should be taken to decrease incidence of adverse neonatal outcome. In post-term pregnancies with adverse outcomes, impedance to flow in umbilical arteries may be increased, while impedance to flow in the fetal middle cerebral arteries may be decreased, but impedance to flow in uterine arteries may be normal
International journal of reproduction, contraception, obstetrics and gynecology, 2022
Background: Fetal blood flow can be studied by Doppler patterns which follow a longitudinal trend with sequential changes in umbilical artery, middle cerebral artery followed by other peripheral arteries. Though FGR cannot be treated but morbidity and mortality can be decreased by studying longitudinal changes in MCA-PI (middle cerebral arterypulsatility index) and MCA-PSV (middle cerebral arterial-peak systolic velocity) and terminating the pregnancy at appropriate time. Methods: A prospective observational study was conducted from 2018 to 2019 on 29 antenatal patients with suspicion of fetal growth restriction at ≥32 weeks gestation. Patients with late onset FGR by Delphi procedure with singleton pregnancy and confirmed gestational age were included. Patients with gross congenital anomaly or multiple pregnancy were excluded. Peak systolic velocity, resistance index and PI in middle cerebral artery were recorded in absence of fetal movements. MCA-PSV >95th percentile and MCA-PI <5th percentile for that gestational age were considered abnormal. The compiled data was subjected to statistical analysis. Results: Mean gestational age was 36.28±1.6 weeks at enrolment and 36.65±1.56 weeks at delivery. The longitudinal changes in MCA-PSV values showed an increase in all the patients but in 11 patients, it was abnormal and out of these there was fall in 6 patients after an increase. MCA-PSV fall was strongly associated with perinatal mortality (p value 0.0003 and kappa 0.664). In 22 patients with increase in MCA-PSV there was decrease in MCA-PI while in 7 patients MCA PI increased which could be due to pseudo normalization phenomenon due to cerebral oedema. Association of MCA-PSV fall with adverse perinatal outcome was not significant (p value >0.05). The sensitivity of MCA-PSV fall in predicting the perinatal mortality was 80% and specificity was 91.76%. Conclusions: MCA-PSV not only complements MCA-PI but also provides more accurate information than does MCA-PI alone and should be used along with MCA-PI for optimizing fetomaternal outcome.
Obstetrical & Gynecological Survey, 1996
Objective: To predict acidosis in fetus showing deceleration associated with non-reassuring fetal status during delivery, we examined the relationship between duration of the deceleration and umbilical arterial pH. Materials and methods: A total of 19,907 deliveries in eight facilities of the Juntendo Perinatal Care Group, 895 cases of vaginal deliveries with level 3 decelerations were selected for the subjects of this study. The cutoff point of time when the umbilical arterial pH fell below 7.20 in all cases of level 3 and for each deceleration type were examined. The explanatory variables were the pH and pO 2 of umbilical arterial gas and the time from onset of the level 3 pattern to delivery. From receiver operating characteristic (ROC) analysis using these variables, the critical point indicating low Apgar score was set at an umbilical arterial pH < 7.20. Results: The cutoff point of time when the umbilical arterial pH fell below 7.2 was 33.5 min for all cases of level 3, and 604 cases of severe variable decelerations with normal baseline variability and normal baseline heart rates, the cutoff point was 33.5 min as well. For 108 cases of late decelerations, there was no significant cutoff point for either the mild or severe cases. Mild prolonged deceleration showed the cutoff point of 34.5 min. Conclusions: We confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important.