Doppler indices of the umbilical and fetal middle cerebral artery at 18–40 weeks of normal gestation: A pilot study

Srikumar, Satyabrat; Debnath, Jyotindu; Ravikumar, R; Bandhu, H.C.; Maurya, Vinay

doi:10.1016/j.mjafi.2016.12.008

Cited by 41 publications

(52 citation statements)

References 18 publications

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“…We found only five articles presenting reference ranges for CPR. Table 1 describes the main characteristics and number of citations of the 19 selected studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] .…”

Section: Resultsmentioning

confidence: 99%

Clinical impact of Doppler reference charts on management of small‐for‐gestational‐age fetuses: need for standardization

Ruiz

Papageorghiou

Staines-Urias

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To assess clinical variability in the management of small‐for‐gestational‐age (SGA) fetuses according to different published Doppler reference charts for umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR). Methods We performed a systematic search of MEDLINE, EMBASE, CINAHL and the Web of Science databases from 1954 to 2018 for studies with the sole aim of creating fetal Doppler reference values for UA, MCA and CPR. The top cited articles for each Doppler parameter were included. Variability in Doppler values at the following clinically relevant cut‐offs was assessed: UA‐pulsatility index (PI) > 95th percentile; MCA‐PI < 5th percentile; and CPR < 5th percentile. Variability was calculated for each week of gestation and expressed as the percentage difference between the highest and lowest Doppler value at the clinically relevant cut‐offs. Simulation analysis was performed in a cohort of SGA fetuses (n = 617) to evaluate the impact of this variability on clinical management. Results From a total of 40 studies that met the inclusion criteria, 19 were analyzed (13 for UA‐PI, 10 for MCA‐PI and five for CPR). Wide discrepancies in reported Doppler reference values at clinically relevant cut‐offs were found. MCA‐PI showed the greatest variability, with differences of up to 51% in the 5th percentile value at term. Variability in the 95th percentile of UA‐PI and the 5th percentile of CPR at each gestational week ranged from 21% to 41% and 15% to 33%, respectively. As expected, on simulation analysis, these differences in Doppler cut‐off values were associated with significant variation in the clinical management of SGA fetuses, despite using the same protocol. Conclusions The choice of Doppler reference chart can result in significant variation in the clinical management of SGA fetuses, which may lead to suboptimal outcomes and inaccurate research conclusions. Therefore, an attempt to standardize fetal Doppler reference ranges is needed. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Resultsmentioning

confidence: 99%

Clinical impact of Doppler reference charts on management of small‐for‐gestational‐age fetuses: need for standardization

Ruiz

Papageorghiou

Staines-Urias

et al. 2020

Ultrasound in Obstet & Gyne

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“…In our study a single cutoff value of 1.08 for MCA/UmbA PI ratio (cerebral-umbilical ratio) was used, above which velocimetry was considered normal and below which it was considered abnormal, according to reference values. 9,10,11 Outcome Criteria Outcome variables included were birth weight (less than 10th percentile), perinatal death, emergency CS for fetal distress, 5 minute Apgar score less than 7, low birth weight with NICU admissions. Pregnancy was considered to have "Adverse outcome" when any of the following complications were present such as perinatal death, emergency CS for fetal distress and admission to NICU for complications of low birth weight.…”

Section: Methods Of Collection Of Datamentioning

confidence: 99%

Role of Colour Doppler in Evaluation of Intrauterine Growth Retardation

Veerabathini¹,

Mohanthy²,

Mukherjee³

et al. 2020

IJCMSR

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Introduction:Most common complication of pregnancy is intrauterine growth restriction which is associated with perinatal mortality, morbidity and neurological impaired development. Doppler of Uterine, umbilical, middle cerebral arteries and cerebro-placental ratio are commonly done for intrauterine growth restriction evaluation. The aim of the study was to evaluate the diagnostic performance of fetal middle cerebral artery and umbilical artery by Doppler ultrasonography in high risk mothers and correlation with perinatal outcome. Material and Methods: Fifty singleton pregnancies beyond 28 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of umbilical and middle cerebral arteries. Results: 40 of the 50 cases included in the study had adverse outcome. The sensitivity of Doppler of the umbilical artery using Pulsatility index was 82.5%, middle cerebral artery Pulsatility index was 77.5% and ratio of middle cerebral artery Pulsatility index / umbilical artery Pulsatility index was 87.5% in predicting perinatal outcome. Conclusion: Pulsatility index ratio of middle cerebral artery / umbilical artery is the most sensitive index in predicting perinatal outcome (87.5%). Umbilical Systolic /Diastolic ratio is the most specific index (80.9%). Absent and reversed diastolic flow in umbilical artery in prenatal sonography carries grave prognosis and high mortality of fetus. Combined use of both umbilical and middle cerebral arterial doppler study including the cerebro-placental ratio increase the sensitivity of the doppler studies for prediction adverse perinatal outcome.

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“…Fetal monitoring using pulsed wave Doppler for umbilical artery, anterior middle cerebral artery (MCA), ductus venosus, and uterine arteries is a routine method in obstetrical practice. It is well established that adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies [1]. Doppler ultrasonography (Doppler US) of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation (IUGR), and other perinatal outcomes [1].…”

Section: Introductionmentioning

confidence: 99%

“…It is well established that adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies [1]. Doppler ultrasonography (Doppler US) of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation (IUGR), and other perinatal outcomes [1]. Fetal anemia, caused mostly by maternal red cell alloimmunization, is evaluated by MCA peak systolic velocity (PSV) Doppler, which remains the gold standard for noninvasive screening of fetal anemia [2].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices

et al. 2019

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Background and objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall—needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner’s hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).

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Doppler indices of the umbilical and fetal middle cerebral artery at 18–40 weeks of normal gestation: A pilot study

Cited by 41 publications

References 18 publications

Clinical impact of Doppler reference charts on management of small‐for‐gestational‐age fetuses: need for standardization

Clinical impact of Doppler reference charts on management of small‐for‐gestational‐age fetuses: need for standardization

Role of Colour Doppler in Evaluation of Intrauterine Growth Retardation

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices

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