Middle cerebral artery Doppler in severe intrauterine growth restriction

Johnson, P.; Stojilkovic, T.; Sarkar, Pampa

doi:10.1046/j.1469-0705.2001.00404.x

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…Fetal brain‐sparing can be detected 2–3 weeks before there are any extreme changes of umbilical blood flow and the appearance of late deceleration on fetal heart rate recordings, but the indices are rarely employed in clinical decision‐making because of quite low diagnostic accuracy16, 17. Normalization of Doppler velocimetric indices of the fetal MCA has also been reported in terminal cases18, 42. This might be a reason for the increase in MCA/uterine artery PI ratio in the two cases with an adverse pregnancy outcome.…”

Section: Discussionmentioning

confidence: 75%

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre‐eclamptic pregnancies

Simanavičiūtė¹,

Gudmundsson

2006

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 75%

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre‐eclamptic pregnancies

Simanavičiūtė¹,

Gudmundsson

2006

Ultrasound in Obstet & Gyne

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“…We found that SGA, poor Apgar scores, and preterm delivery rates were higher in the group with abnormal CU ratio than those with normal CU ratio, but poor outcomes were also seen in those with normal ratio, which indicates that there was not much change in fetal hemodynamic changes before and after treatment in cases of severe preeclampsia. Normalization of the Doppler velocimetric indices of the fetal MCA has also been reported in terminal cases [12, 13]. This could have also resulted in normal CU ratio in patients with severe preeclampsia, although the pathological changes would have already occurred.…”

Section: Discussionmentioning

confidence: 84%

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

Adiga

Kantharaja

Hebbar

et al. 2015

International Journal of Reproductive Medicine

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Aims and Objectives. (i) To determine the predictive value of cerebrouterine (CU) ratio (middle cerebral artery to uterine artery pulsatility index, MCA/UT PI) in assessing perinatal outcome among hypertensive disorders of pregnancy. (ii) To compare between CU ratio and CP ratio (MCA/Umbilical artery PI) as a predictor of adverse perinatal outcome. Methods. A prospective observational study was done in a tertiary medical college hospital, from September 2012 to August 2013. One hundred singleton pregnancies complicated by hypertension peculiar to pregnancy were enrolled. Both CU and CP ratios were estimated. The perinatal outcomes were studied. Results. Both cerebrouterine and cerebroplacental ratios had a better negative predictive value in predicting adverse perinatal outcome. However, both CU and CP ratios when applied together were able to predict adverse outcomes better than individual ratios. The sensitivity, specificity, positive predictive value, and the negative predictive values for an adverse neonatal outcome with CU ratio were 61.3%, 70.3%, 56%, and 78.9%, respectively, compared to 42%, 57.5%, 62%, and 76% as with CP ratio. Conclusion. Cerebrouterine ratio and cerebroplacental ratio were complementary to each other in predicting the adverse perinatal outcomes. Individually, both ratios were reassuring for favorable perinatal outcome with high negative predictive value.

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“…Ghosh GS, et al studied 353growth restricted pregnancies and observed abnormal umbilical artery parameters in 102 patients. 7 Out of the patients showing elevated PI (n=22) and absent/ reversal of diastolic flow (n=18), adverse perinatal outcome was seen in sixty six percent of the patients (n= 33). Highest mortality/ morbidity rate was observed in patients with reverse end diastolic flow followed by those with absent diastolic flow and last was those with raised PI.…”

Section: Umbilical Artery Evaluationmentioning

confidence: 93%

Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

et al. 2016

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Background: Intra uterine growth restricted (IUGR) is when the expected foetal weight is less than 10 th percentile for gestational age. The hemodynamics of the feotus takes into account both the umbilical-placental and cerebral vascular beds. Underlying etiology that results in the failure of a foetus to attain its expected growth may vary. However the final infliction is via uteroplacental insufficiency. It is highlighted that inadequate uteroplacental perfusion is the main and primary pathology in growth restriction resulting in an increased umbilical artery impedance. Following this step are the changes in the middle cerebral artery (MCA) which categorically set in as a secondary phenomenon. Methods: Duplex Doppler Sonography is a reliable, non-invasive and rapid diagnostic technique in IUGR patients. Grey scale findings together with colour Doppler characteristics help in the qualitative as well as quantitative evaluation of the Uteroplacental and Fetoplacental circulation. Hence ultrasonography (USG) has become the most widely used, standard and simple way of detecting and confirming IUGR. Ultrasound biometry is the gold standard for assessment of foetal size. Various criteria are used to label a feotus growth restricted; foetal weight less than 10th percentile for gestational age is mostly widely accepted criterion. Others like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. After establishing the diagnosis of IUGR, Doppler imaging becomes a valuable investigating method for monitoring the pregnancy because it provides information about the hemodynamic status of the feotus. Uteroplacental system evaluation takes into account the flow pattern of uterine artery, reflecting any underlying Uteroplacental vascular ischemia. Umbilical artery Doppler waveforms reflect the status of the fetoplacental circulation and any underlying placental insufficiency. Results: Fourteen cases showed absent umbilical artery end diastolic flow and four patients showed reversal of end diastolic flow.: Twenty two patients showed elevated PI. Adverse perinatal outcome was observed in all patients with absent and reversal of end diastolic flow. Out of the twenty two with elevated PI fifteen showed adverse outcome. Thirty six cases showed low MCA PI and six showed a pseudonormalization. A cerebro-placental ratio of < 1.08 was observed in 16 patients, it was calculated in only those pregnancies that showed forward diastolic flow in umbilical artery (n= 22). Fifteen of them showed adverse perinatal outcome. Conclusions: Doppler imaging is of value for monitoring pregnancies complicated with IUGR because it can provide indirect evidence of foetal compromise and is known to improve outcome of high risk pregnancies. Doppler evaluation is complementary to all other surveillance modalities. Because the changes in umbilical, uterine & MCA strongly correlate with pregnancy outcome in growth rest...

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Middle cerebral artery Doppler in severe intrauterine growth restriction

Cited by 16 publications

References 16 publications

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre‐eclamptic pregnancies

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre‐eclamptic pregnancies

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

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