Changes in uterine artery Doppler velocimetry and circulating angiogenic factors in the first half of pregnancies delivering a small‐for‐gestational‐age neonate

Triunfo, Stefania; Crovetto, F.; Rodrı́guez-Sureda, Vı́ctor; Scazzocchio, Elena; Crispi, F.; Domı́nguez, Carmen; Gratacós, Eduard; Figueras, F.

doi:10.1002/uog.15978

Cited by 24 publications

(30 citation statements)

References 42 publications

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“…In accordance with previous studies 37–40 , we found, that an increased mean UtA-PI at <24 weeks of gestation was mainly associated with late SGA and with SGA at birth. Recent findings suggest that interrogation of fetal vessels at 20–24 weeks of gestation may also play a role in the identification of subsequent development of SGA.…”

Section: Discussionsupporting

confidence: 93%

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

et al. 2017

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Aim: To determine whether Doppler evaluation at 20-24 weeks of gestation can predict reduced fetal size later in pregnancy or at birth. Methods: Fetal biometry and Doppler velocimetry were performed in 2,986 women with a singleton pregnancy at 20-24 weeks of gestation. Predictive performances of the umbilical artery pulsatility index (UA-PI) or the mean uterine artery pulsatility index (UtA-PI) >95th percentile, middle cerebral artery pulsatility index, or cerebroplacental ratio (CPR) <5th percentile for early small for gestational age (SGA; <34 weeks of gestation), late SGA (≥34 weeks of gestation), or SGA at birth (birthweight <10th percentile) were analyzed. Results: The prevalence of early SGA, late SGA, and SGA at birth was 1.1, 9.6, and 14.7%, respectively. A CPR <5th percentile had a positive likelihood ratio (LR+) of 8.2 (95% confidence interval [CI] 5.7-12.0) for early SGA, a LR+ of 1.6 (95% CI 1.1-1.2) for late SGA, and a LR+ of 1.9 (95% CI 1.4-2.6) for SGA at birth. A UtA-PI >95th percentile was associated with late SGA and SGA at birth, while an UA-PI >95th percentile was associated with early SGA. Associations were higher in fetuses with an estimated fetal weight <10th percentile. Conclusion: Fetal biometry and Doppler evaluation at 20-24 weeks of gestation can predict early and late SGA as well as SGA at birth.

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Section: Discussionsupporting

confidence: 93%

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

et al. 2017

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“…Three more had unclear risk of bias in the same category and one had unclear risk of bias in patient selection. The rest of the studies had low risk of bias in all categories. Figures S1 and S2 show risk of bias in the included studies, according to the QUADAS‐2 tool for diagnostic test accuracy reviews.…”

Section: Resultsmentioning

confidence: 99%

“…Mean maternal age at evaluation was 32.2 (SD 1.3) years and mean maternal BMI was 23.4 (SD 1.7) kg/m 2 . Among studies evaluating suspected SGA (numbers are not mutually exclusive), 28% (460/1641) of cases had composite adverse perinatal outcome, 25.9% (555/2147) required admission to the neonatal unit, 17% (187/1102) had CS‐IFC, 1.7% (12/725) had 5‐min Apgar score < 7, 6.1% (78/1279) had neonatal acidosis and 2.7% (5/185) had perinatal death. Among studies evaluating SGA neonates (numbers are not mutually exclusive), 29.7% (265/891) of cases had composite adverse perinatal outcome, 18.6% (165/888) required admission to the neonatal unit, 12.5% (465/3727) had CS‐IFC, 1.8% (65/3540) had 5‐min Apgar score < 7, 3.5% (83/2372) had neonatal acidosis and 0.7% (26/3562) had perinatal death.…”

Section: Resultsmentioning

confidence: 99%

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Martinez‐Portilla

Caradeux

Meler

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTION What are the novel findings of this work?This study provides evidence of a higher risk of adverse outcome in suspected third-trimester small-forgestational-age (SGA) fetuses with abnormal uterine artery Doppler, which is comparable to that in late SGA fetuses with abnormal cerebroplacental ratio. What are the clinical implications of this work?The findings from this study should enable clinicians to assess the risk of adverse perinatal outcome in SGA fetuses, using the likelihood ratios of abnormal third-trimester uterine artery Doppler to calculate the posterior probability, using an evidence-based approach. ABSTRACTObjective To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses.Methods A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95 th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were con-structed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment.Results Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively.Conclusion Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA.

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“…Moreover, similar positive findings have been reported for conditional centiles of EFW, though these findings are contested in more recent studies 11,31,46 . The relationship of longitudinal changes with perinatal outcome in early-onset FGR is sparsely reported [47][48][49] . Some have suggested worse outcome in early-onset growth-restricted fetuses with resolution of cerebral redistribution 48 .…”

Section: Interpretation Of Study Findings and Comparison With Publishmentioning

confidence: 99%

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Changes in uterine artery Doppler velocimetry and circulating angiogenic factors in the first half of pregnancies delivering a small‐for‐gestational‐age neonate

Cited by 24 publications

References 42 publications

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

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