Abstract
Background: Although using Doppler ultrasonography of umbilical structures is a common method for predicting prenatal adverse outcome, recent studies have proposed the importance of middle cerebral artery (MCA) Doppler assessment for antenatal monitoring. The aim of the present study was to compare alterations in the fetalMCAversus umbilical artery (UA) pulsatility indices (PI) in complicated pregnancies by fetal growth restriction (FGR).
 Methods: A cohort study was carried out in Yas Hospital (Tehran, Iran) in 2016. One hundred fifty pregnant women in third trimester with estimation of FGR participated in the study. Transabdominal ultrasound was performed to determine fetal weight. After birth, all neonates were divided into 2 groups: small for gestational age (SGA) and non-SGA.We compared the values of UA and MCA Doppler in predicting SGA. Data were analyzed with t-test and Chi-square test.
 Results: After delivery, 126 mothers had SGA while 24 subjects had non-SGA neonates. Unlike UA PI, MCA artery PI of the SGA and non-SGA groups were significantly different (p=0.062 for UA PI comparison; p=0.0001 for MCA PI comparison). Of the 126 cases, there was decreased MCA PI in 40.5% of fetuses and increased UA PI in 22.2% of fetuses. There were significant differences in both sensitivity and specificity for MCA PI versus UA PI (p=0.014 for sensitivity; p=0.009 for specificity).
 Conclusion: Results showed that of all the SGA cases, a decrease in MCA PI was more notable than changes in UA PI. Sensitivity, specificity and prediction of SGA for MCA PI were higher than those for UA PI.
Highlights
Using Doppler ultrasonography of umbilical structures is a common method for predicting prenatal adverse outcome, recent studies have proposed the importance of middle cerebral artery (MCA) Doppler assessment for antenatal monitoring
More neonates in the small for gestational age (SGA) group were hospitalized in the neonatal intensive-care unit (NICU) and stayed longer compared to neonates in the other group (p=0.04)
We found that the frequency of neonatal respiratory distress syndrome (RDS) among SGA neonates with abnormal MCA pulsatility indices (PI) was significantly higher than in neonates with normal MCA PI (p=0.01)
Summary
Using Doppler ultrasonography of umbilical structures is a common method for predicting prenatal adverse outcome, recent studies have proposed the importance of middle cerebral artery (MCA) Doppler assessment for antenatal monitoring. The aim of the present study was to compare alterations in the fetal MCA versus umbilical artery (UA) pulsatility indices (PI) in complicated pregnancies by fetal growth restriction (FGR). Fetal growth restriction (FGR) is defined as failure to achieve specific fetal biometric measures or estimated weight (less than 10th percentile) by a specific gestational age. Evaluation of an FGR fetus was performed by utilizing electronic fetal monitoring and biophysical profile. These methods have several disadvantages, including false positive findings which lead to waste of time [6]. Doppler velocimetry examination is an improved clinical tool for assessing utero-placental blood flow and resistances in complicated pregnancies by preeclampsia or FGR [7]
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