DOPPLER INDICES OF FETAL MIDDLE-CEREBRAL AND UMBILICAL ARTERIES IN NORMAL 28–40 WEEKS PREGNANCIES
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i4.46756Keywords:
Middle cerebral artery, Umbilical artery, Cerebroplacental ratio, Uterine artery, DopplerAbstract
Objectives: The aim of the study was to establish normative data for the pulsatility index (PI), resistive index, and cerebro placental ratio of umbilical artery (UA), and fetal middle cerebral artery (MCA) of Indian pregnant women in the third trimester of pregnancy using multiples of the median and percentile reference range.
Methods: It was a cross-sectional study; the study was carried out at the Department of Obstetrics and Gynaecology and Radiology in MGM Medical College and LSK Hospital, the tertiary care and teaching hospital. A total of 200 cases were enrolled for this study. Patients with Singleton low-risk pregnancies with confirmed gestational age, normal anatomy, normal estimated fetal weight, and born at term with birth weight between 10th and 90th percentile and gestational age was based on LMP date, corrected if required by trimester first/second (Before 20 weeks) fetal sonographic parameters were included in the study.
Results: We found from 28 weeks to 39 weeks of gestational age, MCA PI showed a significantly positive correlation with the cerebro-placental ratio (CPR) 40th week of gestational age. We found no significant correlation. While from 28 weeks to 40 weeks of gestational age, UA PI showed a significantly negative correlation with the CPR.
Conclusion: Doppler ultrasound is used as a part of the clinical protocol in the surveillance of pregnancies. The UA and MCA Doppler indices and CPR are currently used to modify the scheduling of antepartum surveillance and, in some cases, to timely delivery of the compromised fetus. Researchers measured the pulsatility, resistivity, and cardiac indices of the UA and the fetal MCA between 28 and 40 weeks of gestation to establish a normal range.
Downloads
References
Khong SL, Kane SC, Brennecke SP, da Silva Costa F. First trimester uterine artery Doppler-analysis in the prediction of later-pregnancy complications. Dis Markers 2015;2015:679730. doi: 10.1155/2015/679730
Bao SH, Chigirin N, Hoch V, Ahmed H, Frempong ST, Zhang M, et al. Uterine Radial Artery resistance-index predicts reproductive outcome in women with recurrent pregnancy losses and thrombophilia. Biomed Res Int 2019;2019:8787010. doi: 10.1155/2019/8787010
Figueras F, Gardosi J. Intrauterine growth restriction: New concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol 2011;204:288-300. doi: 10.1016/j.ajog.2010.08.055
Khalil AA, Morales-Rosello J, Elsaddig M, Khan N, Papageorghiou A, Bhide A, et al. The association between fetal Doppler and admission to neonatal unit at term. Am J Obstet Gynecol 2015;213:57.e1-7. doi: 10.1016/j.ajog.2014.10.013
Ebbing C, Rasmussen S, Kiserud T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: Longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol 2007;30:287-96. doi: 10.1002/uog.4088
Vyas S, Nicolaides KH, Bower S, Campbell S. Middle cerebral artery flow velocity waveforms in fetal hypoxaemia. Br J Obstet Gynaecol 1990;97:797-803. doi: 10.1111/j.1471-0528.1990.tb02573.x
Rujiwetpongstorn J, Phupong V. Doppler waveform indices of the Middle Cerebral-Artery of normal fetuses in the first half of pregnancy in the Thai population. Arch Gynecol Obstet 2007;276:351-4. doi: 10.1007/s00404-007-0352-2
Tarzamni MK, Nezami N, Sobhani N, Eshraghi N, Tarzamni M, Talebi Y. Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations’ nomograms. BMC Pregnancy Childbirth 2008;8:50. doi: 10.1186/1471-2393-8-50
Mari G, Deter RL. Middle cerebral artery flow velocity waveforms in normal and small for gestational age fetuses. Am J Obstet Gynecol 1992;166:1262-70. doi: 10.1016/S0002-9378(11)90620-6
Komwilaisak R, Saksiriwuttho P, Ratanasiri T, Kleebkaow P, Seejorn K.Pulsatility index of the middle cerebral artery in normal fetuses. J Med Assoc Thai 2004;87(Suppl 3):S34-7. doi: 10.1016/j.mjafi.2016.12.008
Zohav E, Zohav E, Rabinovich M, Alasbah A, Shenhav S, Sofer H, et al. Third-trimester reference ranges for cerebroplacental-ratio and pulsatility index for middle cerebral artery and umbilical artery in normal-growth singleton fetuses in the Israeli population. Rambam Maimonides Med J 2019;10:e0025. doi: 10.5041/RMMJ.10379
Harrington K, Carpenter RG, Nguyen M, Campbell S. Changes observed in Doppler studies of the fetal circulation in pregnancies complicated by pre-eclampsia or the delivery of a small for gestational age baby. I. Cross-sectional analysis. Ultrasound Obstet Gynecol 1995;6:19-28. doi: 10.1046/j.1469-0705.1995.06010019.x
Nassr AA, Abdelmagied AM, Shazly SA. Fetal cerebro-placental ratio and adverse perinatal outcome: Systematic review and meta-analysis of the association and diagnostic performance. J Perinat Med 2016;44:249-56. doi: 10.1515/jpm-2015-0274
Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, et al. Is fetal cerebroplacental-ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015;213:54.e1-10. doi: 10.1016/j.ajog.2014.10.024
Garcia-Simon R, Figueras F, Savchev S, Fabre E, Gratacos E, Oros D. Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late-onset small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 2015;46:713-7. doi: 10.1002/uog.14807
DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213:5-15. doi: 10.1016/j.ajog.2015.05.024
Published
How to Cite
Issue
Section
Copyright (c) 2022 Dr. Anjali Suman Anjali
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.