Outcome of small-for-gestational-age fetuses according to umbilical artery Doppler: Is there any yield from additional middle cerebral artery Doppler?

Abstract

SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI.

Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review

“…No case of IVH in SGA fetuses with or without CR with normal UA Doppler; seven cases of IVH in SGA with CR and abnormal UA Doppler…”

“…Three studies were performed on term fetuses of > 37 weeks' gestation, four on preterm fetuses and two included both term and preterm fetuses (24–42 weeks) (Table S1). Seven studies recruited SGA fetuses; SGA was defined as birth weight < 10 th percentile in four, as EFW < 10 th percentile in one, as AC < 10 th percentile in one and as AC < 5 th percentile in one. Although two studies reported on fetuses with growth restriction, the definition used in that of Rep et al .…”

“…In studies recruiting only preterm fetuses, UA Doppler was abnormal in three studies (UA‐PI > 95 th percentile and/or A/REDF) and varied from normal to A/REDF in one study. Cerebral redistribution was defined as MCA‐PI < 5 th percentile in five studies, MCA‐PI < 10 th percentile in one study, MCA‐PI < 2 SD in one study, as a raised (> 1.2) UA‐PI/MCA‐PI ratio in one study and as a reduced (< 1) MCA‐RI/UA‐RI ratio in one study. Similarly, neurodevelopmental outcomes were reported using a broad range of scales.…”

“…Five studies ( n = 806) reported on intraventricular hemorrhage (IVH) or other abnormal cranial ultrasound features. Eixarch et al .…”

Middle cerebral artery Doppler

“…Nanthakomon et al concluded that "SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI [1] . " I agree that the authors showed the possible clinical usefulness of this Doppler application.…”