Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements

Ebbing, Cathrine; Rasmussen, Svein; Kiserud, Torvid

doi:10.1002/uog.4088

Cited by 246 publications

(305 citation statements)

References 47 publications

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“…Kurmanavicius J et al 12 in a cross sectional study involving 331 normal pregnancies between 19-40 weeks also showed that MCA-PSV increases with increasing period of gestation and the 5 th percentile of both the studies were similar however the 50 th and 95 th of our study were higher than the study conducted by Kurmanavicius J et al Ebbing et al 10 in a study with 161 singleton pregnancies between 19-40 weeks period of gestation also showed that the MCA-PSV increases with increasing gestational age but the reference values were lower than this study. Tongsong et al 11 in a prospective cross-sectional descriptive study in which low-risk singleton pregnancies with accurate gestational age were recruited into the study showed a continuous increase in MCA-PSV over the period from 11-22 weeks.…”

Section: Discussionsupporting

confidence: 60%

Reference Values of Fetal Peak Systolic Velocity in the Middle Cerebral Artery at 19–40 Weeks of Gestation in Nepalese Population

Shrestha¹,

Shrestha²,

Ghimire³

et al. 2014

Nepal j. obstet. gynaecol.

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Aims:The purpose of this study was to construct new reference range for fetal middle cerebral artery peak systolic velocity (MCA-PSV) in uncomplicated pregnancy at 19-40 weeks of gestation. Methods:This was a prospective cross-sectional study involving 400 singleton pregnancies between 19 and 40 weeks of gestation without any known risk factors of adverse pregnancy outcome who were referred for routine obstetric examination. The protocol included the doppler examination of fetal middle cerebral artery (MCA) within 2 mm after its origin from the internal carotid artery and data were used to construct the normograms and percentile fitted curves of each doppler parameter for different gestational age.Results: Among 400 singleton uncomplicated pregnancies between 19 and 40 weeks of gestation maximum number of pregnancies (10%) was at 19 weeks of gestation and minimum (2.5%) was at 31 weeks. The fetal peak systolic blood flow in the MCA showed significant correlation with period of gestation. Mean MCA-PSV was 22.35 ± 3.05 at 19 weeks of gestation which increased to 67.73 ± 9.92 at 40 weeks. The MCA-PSV showed continuous increment with increasing gestational age Conclusions: Continuous increment in the peak systolic volume with advancing gestational age was obtained which was consistent with the previous studies done by various authors. The percentile fitted values and normograms will be valuable for the serial measurement of the peak systolic volume of the middle cerebral artery for complicated pregnancies.

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Section: Discussionsupporting

confidence: 60%

Reference Values of Fetal Peak Systolic Velocity in the Middle Cerebral Artery at 19–40 Weeks of Gestation in Nepalese Population

Shrestha¹,

Shrestha²,

Ghimire³

et al. 2014

Nepal j. obstet. gynaecol.

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“…However, in normal fetuses, CPR normally falls after 34 weeks of gestation [66,69]. It is conceivable that the rate and/or magnitude of this fall might be greater in at risk fetuses.…”

Section: Fetal Dopplermentioning

confidence: 99%

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth. HIGHLIGHTS Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, the majority of fetuses suffering from stillbirth at term are not small for gestational age. Serial measurements to assess growth velocity, combined with fetal Doppler, are preferable than a single point estimate. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term  The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth Highlights (for review) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 ABSTRACT Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the t...

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“…This result is similar to that obtained by C. Ebbing et al, 2007, from a longitudinal study involving 161 singleton pregnancies. 30 However, our reference values had narrow range as compared to theirs probably due to small sample size and the cross sectional design of our study.Significant correlation of S: D ratio with period of gestation (r = -0.562, p <0.0001) was obtained in our study. This finding is similar to the result obtained by Justin C. Konje et al, 2005 from a prospective longitudinal study of 70 women.…”

mentioning

confidence: 55%

Reference values for Doppler indices of the umbilical and fetal middle cerebral arteries in uncomplicated third trimester pregnancy

Paudel

Lohani

Gurung

et al. 2011

Journal of Institute of Medicine

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Introduction: The purpose of this study was to categorize new reference ranges for measurements of commonly used umbilical artery and fetal middle cerebral artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) in uncomplicated third trimester pregnancy. Methods:This was a prospective cross sectional study involving 101 singleton uncomplicated pregnancies of 30 to 37 weeks of gestation. Umbilical artery indices were obtained from free floating loop and middle cerebral Doppler indices were obtained from the proximal third of the artery with flow towards the probe. Regression equations were used to categorize reference ranges and percentile fitted Normograms were obtained for all the parameters.Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida women and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established percentiles of Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001). Conclusions:Reference ranges were obtained for the middle cerebral artery and umbilical artery Doppler indices. These ranges are consistent with similar studies done by other authors.Keywords: Doppler study, fetal Middle cerebral artery, pulsatility index, resistance index, systolic, diastolic ratio, umbilical artery deaths among normally formed babies when the results of the umbilical artery Doppler are made available to clinicians. 2,12 By contrast, the value of Doppler velocimetry in the assessment of low-risk populations has not been proven. 13,16 Increasingly, however, attention is being paid to the changes in the circulation within the fetus as a means of determining other alterations that may reflect intrauterine compromise. Studies of the relationship between Doppler of the umbilical arteries and umbilical venous blood gases have concluded that alterations in circulation preceded the onset of Original article 5-13 6Journal of Institute of Medicine, December, 2010; 32:3 www.jiom.com.np hypoxia. 17,18 These changes are likely to be subtle in the early phases and therefore unlikely to be identified from single artery Doppler studies. Different attempts have therefore been made to study several vessels to improve identification of the compromised fetus. 19Arduini and Rizzo in a cross-sectional study of four fetal vessels demonstrated that a combination of the middle cerebral and umbilical artery Doppler indices to produce ratios provided the best method of predicting perinatal outcome. 20These ratios, they concluded, reflected hemodynamic changes better than single vessel Doppler indices. More recently, Meyberg et al demonstrated that Doppler velocimetry of four fetal vessels was better at identifying compromised fetuses in an at-risk population. 21So combining umbilical artery Doppler parameters with middle cerebral artery Doppler indices would reflect the best w...

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Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements

Abstract: Objectives

Cited by 246 publications

References 47 publications

Reference Values of Fetal Peak Systolic Velocity in the Middle Cerebral Artery at 19–40 Weeks of Gestation in Nepalese Population

Reference Values of Fetal Peak Systolic Velocity in the Middle Cerebral Artery at 19–40 Weeks of Gestation in Nepalese Population

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Reference values for Doppler indices of the umbilical and fetal middle cerebral arteries in uncomplicated third trimester pregnancy

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