Effect of Fetal Movements and Fetal Breathing on Fetal Middle Cerebral Artery Pulsatility Index Measurement

Anirudh Badade,Amar Bhide,K Khatal

doi:10.4236/ojog.2018.84039

Abstract

Objective: This study aimed to determine the effect of fetal movements on the MCA pulsatility index (PI) and quantify the fall of MCA PI after initiation of fetal movements and/or breathing, and the time taken to recover from a fall below the 5th percentile. Methods: 16 women with appropriate for gestational age (AGA) fetuses and 16 women with small for gestational age (SGA) fetuses were recruited. MCA PI during “no movement” state was compared with MCA PI values during fetal body movements and breathing movements. Results: MCA PI measurements with body or breathing movements were significantly (p < 0.005) lower as compared to that observed without movements. MCA PI started rising immediately after cessation of body movements and/or breathing movements. Conclusions: MCA PI with fetal body or breathing movements is significantly lower as compared to that observed in the quiet state. If MCA PI measurement is below 5th centile, it should be measured again up to 90 seconds after cessation of fetal body and/or breathing movements in order to minimize false positive diagnosis of cerebral sparing effect in SGA as well as AGA fetuses.

Highlights

Middle cerebral arterial (MCA) Doppler is an important investigation in the assessment of fetal oxygenation status [1]
We hypothesized that if the MCA pulsatility index (PI) fell below the 5th centile in appropriate for gestational age (AGA) or small for gestational age fetuses due to fetal movements, it may have the potential to create a false positive diagnosis of cerebral sparing effect
Cerebral sparing effect was said to be present if the MCA PI was below the 5th centile even in absence of fetal body or breathing movements

Summary

Introduction

Middle cerebral arterial (MCA) Doppler is an important investigation in the assessment of fetal oxygenation status [1]. MCA PI nomograms are available and values below the 5th centile are interpreted as representing hypoxia-induced cerebral-sparing effect [3]. Several studies in literature have noted the variation of fetal Doppler indices with fetal behavioral states and fetal movement [9]. We hypothesized that if the MCA PI fell below the 5th centile in appropriate for gestational age (AGA) or small for gestational age fetuses due to fetal movements, it may have the potential to create a false positive diagnosis of cerebral sparing effect. A systematic search of published literature did not show any definite studies quantifying the degree of fall of MCA PI due to fetal movements

Methods

Results

Discussion

Conclusion