Fetal middle cerebral artery Doppler indices and clinical application at Korle Bu Teaching Hospital, Accra, Ghana

Seffah, J.D.; Swarray‐Deen, Alim

doi:10.1016/j.ijgo.2015.11.027

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…At this time, the brain is not well developed, the blood vessels are slender, and the resistance is high. To ensure brain development, the MCA-PI decreases significantly at 37 to 41 +6 weeks, [10,11] as observed in the neonates without acidosis in the present study. When fetal hypoxia occurs, blood flow is redistributed to ensure the brain's blood supply (the “brain protective effect”).…”

Section: Discussionsupporting

confidence: 60%

Prediction of neonatal acidosis using the cerebroplacental ratio at different gestational weeks

Guo

Chai²,

Guo³

et al. 2019

Medicine

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We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy. From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 +6 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI). In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values ( P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 +6 weeks, 32 to 36 +6 weeks, and 37 to 41 +6 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values ( P < .05). The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.

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Section: Discussionsupporting

confidence: 60%

Prediction of neonatal acidosis using the cerebroplacental ratio at different gestational weeks

Guo

Chai²,

Guo³

et al. 2019

Medicine

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“…For example, the top three most cited studies (those of Arduini and Rizzo 24 , Baschat and Gembruch 25 and Acharya et al 26 ) show an important risk of bias owing to the fact that they are only the sixth, eleventh and ninth ranked studies based on methodological quality according to a recently published systematic review 18 . It could be argued that older studies are more likely to be cited than are more recent ones with higher-quality methodology because the results of newer studies might not have had sufficient time to be incorporated into clinical practice 52 .…”

Section: This Is the First Systematic Review To Analyze The Impact Ofmentioning

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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“…Comparison of PI of UA, PI of MCA, and CPR as a percentage of pregnancy for our guinea pig data and human published studies (Medina-Castro et al [ 24 , 25 ], Parra-Cordero et al [ 26 ], Arduini et al [ 27 ], Seffah et al [ 28 ], Bahlmann et al [ 29 ], Morales-Roselló et al [ 30 ], Ebbing et al [ 31 ], and Baschat et al [ 32 ], previously summarized in Oros et al 2019 [ 20 ]) are shown in Figure 7 D–F. This analysis revealed that, in both guinea pig and human datasets, UA PI decreased across pregnancy, with a tendency to stabilize in the last third of pregnancy ( Figure 7 D).…”

Section: Resultsmentioning

confidence: 67%

Developmental Ultrasound Characteristics in Guinea Pigs: Similarities with Human Pregnancy

Candia

Jiménez

Navarrete

et al. 2023

Veterinary Sciences

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Background: Biometrical and blood flow examinations are fundamental for assessing fetoplacental development during pregnancy. Guinea pigs have been proposed as a good model to study fetal development and related gestational complications; however, longitudinal growth and blood flow changes in utero have not been properly described. This study aimed to describe fetal and placental growth and blood flow of the main intrauterine vascular beds across normal guinea pig pregnancy and to discuss the relevance of this data for human pregnancy. Methods: Pregnant guinea pigs were studied from day 25 of pregnancy until term (day ~70) by ultrasound and Doppler assessment. The results were compared to human data from the literature. Results: Measurements of biparietal diameter (BPD), cranial circumference (CC), abdominal circumference, and placental biometry, as well as pulsatility index determination of umbilical artery, middle cerebral artery (MCA), and cerebroplacental ratio (CPR), were feasible to determine across pregnancy, and they could be adjusted to linear or nonlinear functions. In addition, several of these parameters showed a high correlation coefficient and could be used to assess gestational age in guinea pigs. We further compared these data to ultrasound variables from human pregnancy with high similarities. Conclusions: BPD and CC are the most reliable measurements to assess fetal growth in guinea pigs. Furthermore, this is the first report in which the MCA pulsatility index and CPR are described across guinea pig gestation. The guinea pig is a valuable model to assess fetal growth and blood flow distribution, variables that are comparable with human pregnancy.

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Fetal middle cerebral artery Doppler indices and clinical application at Korle Bu Teaching Hospital, Accra, Ghana

Abstract: The reference curve for the peak systolic velocity increases with gestational age, whereas the other indices decrease in a parabolic pattern.

Cited by 8 publications

References 23 publications

Prediction of neonatal acidosis using the cerebroplacental ratio at different gestational weeks

Prediction of neonatal acidosis using the cerebroplacental ratio at different gestational weeks

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

Developmental Ultrasound Characteristics in Guinea Pigs: Similarities with Human Pregnancy

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