Fetal aortic isthmus Doppler assessment to predict the adverse perinatal outcomes associated with fetal growth restriction: systematic review and meta-analysis

Abstract

Purpose Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR. Methods PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle–Ottawa Scale. DerSimonian and Laird’s random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2 statistics. Results A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow. Conclusion Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.

Intrauterine Growth Restriction: Need to Improve Diagnostic Accuracy and Evidence for a Key Role of Oxidative Stress in Neonatal and Long-Term Sequelae

“…Recent studies highlighted that novel Doppler variable combinations such as the cerebral–placental–uterine ratio using the pulsatility indices (PIs) of the middle cerebral artery, the umbilical artery, and the uterine arteries, have a higher predictive accuracy for identifying IUGR than Doppler measurements of only the umbilical artery [ 17 ]. The presence of retrograde blood flow in the aortic isthmus may be an additional indication of an increased risk of perinatal death, stillbirth, and respiratory distress syndrome in IUGR patients [ 18 ]. In late-onset IUGR, abnormal cerebroplacental ratio (CPR, i.e., the PI of the middle cerebral artery divided by PI of the umbilical artery) indicates the risk of hypoxemia more sensitively than the PIs of the middle cerebral artery or umbilical artery alone.…”