Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high‐risk population: systematic review and bivariate meta‐analysis

Morris, RK; Malin, GL; Robson, SC; Kleijnen, Jos; Zamora, Javier; Khan, Khalid S.

doi:10.1002/uog.7767

Cited by 74 publications

(32 citation statements)

References 50 publications

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“…Maternal history of a prior SGA newborn with normal fetal growth in the current pregnancy is not an indication for antenatal fetal heart rate testing, biophysical profile testing, or umbilical artery Doppler velocimetry (103). Any patient with a prior birth of an SGA newborn should have her medical and obstetric histories reviewed to help identify any additional risk factors, particularly modifiable risk factors.…”

Section: How Should Women With a Prior Birth Of A Small For Gestationmentioning

confidence: 99%

Practice Bulletin No. 134

2013

Obstetrics &Amp; Gynecology

507

128

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Fetal growth restriction, also known as intrauterine growth restriction, is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. An additional challenge is the difficulty in differentiating between the fetus that is constitutionally small and fulfilling its growth potential and the small fetus that is not fulfilling its growth potential because of an underlying pathologic condition. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery.

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Section: How Should Women With a Prior Birth Of A Small For Gestationmentioning

confidence: 99%

Practice Bulletin No. 134

2013

Obstetrics &Amp; Gynecology

507

128

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“…A recent meta-analysis concluded that umbilical artery velocity patterns were moderately useful in predicting fetal distress. 11 Doppler ultrasound measurements at the middle cerebral artery (MCA) have showed brain sparing physiology by detecting reductions in the pulsatility of blood flow in cases of fetal growth restriction 12 and in fetuses with congenital heart disease. 13 Doppler ultrasound measures the velocity of the flowing blood but does not provide direct information on fetal oxygenation.…”

Section: Introductionmentioning

confidence: 99%

Brain Sparing in Fetal Mice: BOLD MRI and Doppler Ultrasound Show Blood Redistribution During Hypoxia

Cahill

Zhou

Seed

et al. 2014

J Cereb Blood Flow Metab

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Mice reproduce many features of human pregnancy and have been widely used to model disorders of pregnancy. However, it has not been known whether fetal mice reproduce the physiologic response to hypoxia known as brain sparing, where blood flow is redistributed to preserve oxygenation of the brain at the expense of other fetal organs. In the present study, blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and Doppler ultrasound were used to determine the effect of acute hypoxia on the fetal blood flow in healthy, pregnant mice. As the maternal inspired gas mixture was varied between 100% and 8% oxygen on the timescale of minutes, the BOLD signal intensity decreased by 44±18% in the fetal liver and by 12±7% in the fetal brain. Using Doppler ultrasound measurements, mean cerebral blood velocity was observed to rise by 15±8% under hypoxic conditions relative to hyperoxia. These findings are consistent with active regulation of cerebral oxygenation and clearly show brain sparing in fetal mice.

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“…Given these recommendations (pertinent only in the setting of a SGA fetus), current practice in some quarters of incorporating the CPR (or even MCA‐PI) when the EFW is >10 th centile (unless there is also evidence of reduced AC or EFW growth velocity) into clinical management should be discouraged. There is precedence for our view: in the USA, routine UA and MCA Doppler measurement in the setting of appropriate fetal growth often does not attract any insurance reimbursement as these parameters have been shown to be of benefit only in high‐risk populations and of limited prognostic value for fetal or neonatal wellbeing.…”

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confidence: 99%