Fetal Middle Cerebral Artery and Umbilical Artery Pulsatility Index Doppler Associations With Pregnancy Risk and Neonatal Outcomes

Abstract

OBJECTIVE:To evaluate the role of the middle cerebral artery (MCA) to the umbilical artery (UA) blood velocity waveform’s pulsatility index (PI) screening in proximity to delivery as a predictor of high-risk pregnancy and neonatal outcomes.METHODS:The study used a nested case–control method, consisting of 34 women with high-risk pregnancies and 34 pregnant women who were classified as normal. The MCA/UA PI ratio was evaluated within 14 days before delivery. All subjects’ newborns were evaluated for neonatal outcomes, which included fetal distress, abnormal cardiotocography or fetal heart rate patterns, neonatal mortality, Apgar score, duration of hospitalization, and neonatal intensive care unit (NICU) admission. A cutoff point for MCA/UA PI ratio was assessed using the receiver operating characteristic curve. The correlations between the MCA/UA PI ratio and high-risk pregnancy and neonatal outcomes were assessed with multivariable linear regression based on the cutoff point obtained.RESULTS:The MCA/UA PI ratio in high-risk pregnancy was significantly lower compared with normal pregnancy (p= .011). The MCA/UA PI ratio of ≤1.32 finding was 6.37 times higher in high-risk pregnancy (p= .017, AOR 6.37, 95% CI 1.40–28.97), 5.9 times higher in pregnancy with the neonate’s first-minute Apgar less than 7 (p= .031, AOR 5.90, 95% CI 1.18–29.61), and 18.62 times higher in neonates admitted to the NICU (p= .023, AOR 18.62, 95% CI 1.43–2702.94).CONCLUSIONS:Low MCA/UA PI is associated with high-risk pregnancies and adverse neonatal outcomes, such as low first-minute Apgar score and NICU treatment.