Background Studies on blood flow velocity in the fetal middle cerebral artery have revealed signs of brain sparing in chronic hypoxia. These signs of brain sparing can disappear in the terminal case, but whether this applies to the whole brain or only parts of it is unknown.Methods Velocity waveforms of the middle cerebral, anterior cerebral and posterior cerebral arteries were recorded in 221 pregnancies complicated by pregnancy-induced hypertension. The presence of brain sparing (pulsatility index < 2 standard deviations) was noted and correlated to outcome of pregnancy, including emergency operative intervention and/or neonatal distress. ResultsSigns of brain sparing in the anterior cerebral artery were found in 90 fetuses, and in the middle cerebral and posterior cerebral arteries in 52 and 65, respectively. Signs of brain sparing in the anterior cerebral artery showed the strongest relationship to adverse perinatal outcome. The anterior cerebral artery was the only vessel in which signs of brain sparing were predictive of perinatal mortality.Conclusions Velocimetry of the anterior cerebral artery appears to be superior to that of the middle cerebral and posterior cerebral arteries as a means to predict adverse perinatal outcome. Anterior cerebral artery brain sparing may therefore be less transitory than sparing in the middle cerebral and posterior cerebral arteries, possibly suggesting that the frontal lobes are spared longer than the lateral and occipital regions of the fetal brain.

The addition of color Doppler imaging to pulsed wave Doppler ultrasound recording of uterine artery blood velocity improves the predictive value of blood velocity waveforms with regard to the perinatal outcome.

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ABSTRACT

Background-The aim of the study was to evaluate the relation between maternal placental Doppler velocimetry, levels of the maternal glucose, and clinical signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus. Methods and Results-A retrospective study of 155 pregestational diabetic women between the 22nd and 40th weeks of pregnancy, categorized in White classification as B, 49; C, 40; D, 22; R,20; F,5; and RIF,19. Cases in classes R, F, and R/F were defined as having vasculopathy. Doppler velocimetry of umbilical and uterine arteries was evaluated for vascular impedance, both in terms of pulsatility index (PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was a correlation between levels of HbA lc and increased vascular impedance in the uterine and umbilical arteries. Signs of increased uterine artery vascular impedances were significantly related to pregestational vasculopathy. In cases of small-for-gestational-age newborn infants, PI was significantly increased in uterine and umbilical arteries. Furthermore, PI in macrosomic fetuses was significantly lower than in normal infants. Abnormal uterine artery Doppler was also strongly related to adverse outcome. Conclusions-Abnormal