Correlation of fetal middle cerebral artery Doppler indices in IUGR pregnancies (original) (raw)
Related papers
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 Medical Arts
Background: Disorders related to intra-uterine fetal growth usually had different perinatal morbidity and mortality. Accurate diagnosis of intrauterine fetal growth is a challenging difficult task, but recent technological advances are associated with significant improvements with positive impact on antenatal care. Aim of the work: The aim of this study was to evaluate the accuracy of the umbilical and middle cerebral artery Doppler indices [e.g. resistance index] in prediction of fetal outcome in pregnancies with intra-uterine growth restriction (IUGR). Patients and Methods: Forty-five pregnant females had been included in a prospective study. All had a confirmed diagnosis of IUGR. Doppler ultrasound used to record fetal middle cerebral artery [MCA] and umbilical and Doppler indices every one week (from 32 weeks onwards). Post-delivery birth weight, Apgar score at 0 and 5 minutes had been measured and correlated with Doppler indices. Results: One-fifth of the mothers participating in the study (20%) had pre-term birth and 6.7% missed the follow-up. Umbilical artery resistance index (RI) at a cut off value of (0.79) had a diagnostic accuracy of 93%. MCA RI best cut off value was 0.63 with diagnostic accuracy of 73.9%. Also, for C/U ratio had diagnostic accuracy of 92.9%. Finally, there was significant, proportional correlation between MCA RA and C/U ratio from one side and APGAR score at 0 and 5 minutes from the other side. However, the correlation between UARI and Apgar score was inverse and statistically significant. Conclusion: Doppler velocimetry of fetal circulation can provide important information regarding fetal well-being, with subsequent impact on fetal outcome.
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.
BIRDEM Medical Journal, 2012
This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation. It was observed from Correlation analysis between Doppler indices with independent gestational age that all the Do...
Journal of Surgery and Medicine
Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and a...
BIRDEM Medical Journal, 2012
This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation.
The Scientific World Journal, 2016
Objective. To elaborate curves of longitudinal reference intervals of pulsatility index (PI) and systolic velocity (SV) for uterine (UtA), umbilical (UA), and middle cerebral arteries (MCA), in low risk pregnancies. Methods. Doppler velocimetric measurements of PI and SV from 63 low risk pregnant women between 16 and 41 weeks of gestational age. Means (±SD) for intervals of gestational age and percentiles 5, 50, and 95 were calculated for each parameter. The Intraclass Correlation Coefficients (ICC) were also estimated for assessing intra- and intervariability of measurements. Results. Mean PI of UtA showed decreasing values during pregnancy, but no regular pattern was identified for mean SV. For UA, PI decreased and SV increased along gestation. MCA presented PI increasing values until 32–35 weeks. SV showed higher levels with increasing gestation. High ICC values indicated good reproducibility. Conclusions. Reference intervals for the assessment of SV and PI of UtA, UA, and MCA we...