Cerebroplacental Ratio Research Articles

Doppler Indices of the Fetal Middle Cerebral and the Umbilical Arteries in Pregnancies at High Risk Followed Up for Suspected Fetal Growth Restriction

Background: Fetal growth restriction is related to compromised perinatal outcomes. The screening and prevention tools for fetal growth restriction like Doppler indices in high-risk groups compared with general antenatal populations. An evaluation of the correlation between Doppler indices and placental weight and birth weight of the neonate at term pregnancy in high-risk pregnancies is essential. For the early detection of fetal growth limitations in high-risk pregnancies, sensitive screening techniques are few. Objectives: To determine the most accurate indicator for predicting a poor perinatal outcome or intrauterine growth restriction by comparing and correlating the modifications in Doppler ultrasound studies of fetal circulation in general pregnant women with those of high-risk patients both with and without intrauterine growth retardation. Study design: A cross-sectional research including 81 healthy pregnancies and 19 high-risk patients at 31–40 weeks of gestation was conducted. The pulsatility index (PI) of the middle cerebral artery (MCA), the umbilical artery (UA), and the MCA PI to UA PI ratio were all analyzed. We compared the Doppler indices' mean values. Then these values were correlated with placental weight and birth weight of the offspring. Results: A significantly low birth weight and less fetoplacental ratio and placental coefficient ratio were found in high-risk cases than in normal pregnant women (P <0.05). A strong positive relationship was observed between the middle cerebral artery pulsatility index and placental weight, while negative relationship between the pulsatility index of the middle cerebral artery and the Feto-placental ratio (P < 0.05). In addition, a positive association was found between the pulsatility index of the middle cerebral artery and placental coefficient, whereas a negative correlation was observed between the Cerebro-placental ratio and Feto-placental ratio in high-risk cases (P <0.05). Conclusion: Low birth weight can be predicted using Doppler indices since there is a definite correlation between it and unfavorable perinatal outcomes. KEY WORDS: Placenta, birth weight, Doppler indices, Middle cerebral artery pulsatility index, Umbilical artery pulsatility index.

Evaluation of Doppler indices (MCA & UA) and fetal outcomes: a retrospective case-control study in women with hypertensive disorders of pregnancy

Background Hypertensive disorders of pregnancy (HDP) is associated with an increased risk of adverse outcomes. The fetal middle cerebral artery (MCA) and umbilical artery (UA) blood flow detected by ultrasound are recommended to evaluate the oxygenation of the fetus. It is necessary to analyze the relationship between MCA & UA doppler indices or cerebroplacental ratio (CPR) and fetal outcomes and describe MCA and UA blood flow values across gestation. Methods Hospital-based retrospective case-control study during 2016 to 2020. 800 singleton pregnant women: 400 normotensive control, 219 gestational hypertension (GH), and 181 preeclampsia (PE)/eclampsia (EC). An analysis of the outcomes of mothers and neonates was performed. The fetal MCA and UA blood flow values across gestation were established, and MCA-resistance index (RI) and CPR were used to predict fetal distress and small for gestational age (SGA). Results In the normotensive control, GH and PE/EC groups, the mean gestational age (GA) was 38.9 ± 1.2 weeks, 39.0 ± 1.0 weeks, and 38.6 ± 1.3 weeks respectively, and the mean birth weight (BW) was 3.195 ± 0.387 kilograms, 3.198 ± 0.428 kilograms, and 2.987 ± 0.544 kilograms respectively. There were differences in GA, BW, fetal distress, SGA and intraventricular hemorrhage I-II between the hypertension group and normotensive control group (p < 0.05). The MCA-RI (sensitivity: 70.1%, specificity: 64.3%) and MCA-RI (sensitivity: 52.4%, specificity: 84.6%) were the best indices to predict fetal distress and SGA, respectively during GA of 35-40 weeks. Conclusions Fetal MCA blood flow values and CPR are of great benefit for obstetricians to evaluate the status of fetus evidentially in singleton pregnancy.

“TO ASSESS FETO-MATERNAL CIRCULATION BY DOPPLER STUDY IN WOMEN WITH THIRD TRIMESTER AND ITS CO RELATION WITH FETO-MATERNAL OUTCOMES.”

INTRODUCTION : Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity throughout the world, accounting for 24% of all maternal deaths in India. 1,2 In developed countries, it accounts for 7-10% of perinatal mortality and 20% in developing countries. Early detection of preeclampsia may allow for vigilant antenatal surveillance and timely foetal delivery to avoid serious complications. The aim of the study was to determine and compare the diagnostic performance of Doppler sonography of fetal middle cerebral artery (MCA) and umbilical artery (UA) in prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and severe PE. METHODOLOGY: 100 pre-eclampsia patients were taken in study at Sir T. General Hospital, Bhavnagar from January 2021 to July 2022. The various measures of central tendencies and graphical representations were used to analyse the data. RESULTS: Majority of patients were in the age group of 26-30 years. Maximum incidence was seen with primigravida (65%).Out of all patients maximum patients delivered normally (67%). Patients delivered low birth weight babies were around 38%. Umbilical Artery Doppler parameters such as abnormal S/D ratio,Elevated Resistivity index, and elevated Pulsatility Index were found as (78.72%), (80.85%) and (87.23%) in Adverse Outcome event which is statistically signicant compared to Good outcome(p&lt;0.0001). Middle cerebral artery Doppler parameters such as abnormal S/D ratio, Elevated Resistivity index, and elevated Pulsatility Index are found as (25.53%),(76.59%) and (72.34%) in Adverse Outcome event which is statistically signicant compared to Good outcome(p&lt;0.0001). In addition, Cerebro Placental Ratio have found signicantly high abnormality (89.36%) of neonates in adverse group. CONCLUSION: The Doppler technology is helpful in repetitive noninvasive haemodynamic monitoring of pregnancy. In an obstetric patient population with a high prevalence of complications like preeclampsia, the Doppler indices from the fetal circulation can reliably predict adverse perinatal outcomes. Thus the appropriate timing of delivery is to be made before these changes occur. However, the Doppler study of multiple vessels helps predict adverse outcomes , manage high-risk pregnancies complicated by preeclampsia

Developmental Ultrasound Characteristics in Guinea Pigs: Similarities with Human Pregnancy.

Biometrical and blood flow examinations are fundamental for assessing fetoplacental development during pregnancy. Guinea pigs have been proposed as a good model to study fetal development and related gestational complications; however, longitudinal growth and blood flow changes in utero have not been properly described. This study aimed to describe fetal and placental growth and blood flow of the main intrauterine vascular beds across normal guinea pig pregnancy and to discuss the relevance of this data for human pregnancy. Pregnant guinea pigs were studied from day 25 of pregnancy until term (day ~70) by ultrasound and Doppler assessment. The results were compared to human data from the literature. Measurements of biparietal diameter (BPD), cranial circumference (CC), abdominal circumference, and placental biometry, as well as pulsatility index determination of umbilical artery, middle cerebral artery (MCA), and cerebroplacental ratio (CPR), were feasible to determine across pregnancy, and they could be adjusted to linear or nonlinear functions. In addition, several of these parameters showed a high correlation coefficient and could be used to assess gestational age in guinea pigs. We further compared these data to ultrasound variables from human pregnancy with high similarities. BPD and CC are the most reliable measurements to assess fetal growth in guinea pigs. Furthermore, this is the first report in which the MCA pulsatility index and CPR are described across guinea pig gestation. The guinea pig is a valuable model to assess fetal growth and blood flow distribution, variables that are comparable with human pregnancy.

A Prospective Study on Correlation of Cerebroplacental Ratio with Perinatal Outcome in Pregnancy with Iugr

A Prospective Study on Correlation of Cerebroplacental Ratio with Perinatal Outcome in Pregnancy with Iugr

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality &amp; morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely &amp; accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC &amp; PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine &amp; umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases &amp; all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Cerebroplacental ratio as an indicator of placental functioning and its relationship with early communicative gestures acquisition

BackgroundGestures are linked to developmental and neurological development. Cerebroplacental ratio (CPR) has proven to be a good predictor of neurological damage within the growth-restricted fetuses’ population. However, its usefulness in the general population has not been studied for this purpose. The aim of this study was to evaluate the usefulness of CPR as a predictor of gesture acquisition. MethodA prospective cohort of 35 singleton pregnancies with normally grown fetuses was recruited. Doppler indices for the umbilical artery (UA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR) at 36–40 weeks of gestation were recorded. MacArthur-Bates I Communication Skills Development Questionnaires (SCDI) at 12 (±1) months of age were applied. Based on their gesture performance, they were divided into Normal Scores (NS), and Low Scores (LS). ResultsThe independent samples t-test analysis revealed a significant difference between the NS group and LS in terms of CPRz scores (t=2.706, p=.011). CPR z-scores values showed a positive correlation with early gesture centiles (R2=0.145, p=.029) and late gesture centiles (R2=0.178, p=.014). ConclusionCPR within the last weeks of pregnancy could be of potential utility to predict gesture acquisition.

Role of Cerebro-Placental Ratio in Predicting Adverse Outcomes in Low-Risk PregnanciesA Prospective Cohort Study

Introduction: Abnormal Cerebro-Placental Ratio (CPR) is associated with a substantial risk of adverse perinatal outcomes and the test seems to be particularly useful for follow-up of foetuses with sonographically diagnosed Foetal Growth Restriction (FGR). Aim: To determine the usefulness of doppler velocimetry, especially CPR at 35 weeks of gestation or later, in predicting intrapartum foetal heart rate abnormalities and adverse neonatal outcomes in low-risk term pregnancies. Materials and Methods: The present prospective cohort study was conducted at the Department of Obstetrics and Gynaecology in Bangalore Baptist Hospital, Bangalore from September 2019 to September 2020. A total of 60 pregnant women between the ages of 18 and 35 years with low-risk pregnancies, who present for the obstetrical ultrasound at 35 weeks of gestation or later with planned delivery at the hospital were included. All lowrisk pregnant women with estimated foetal weight (EFW) &gt;10th centile and abnormal Cerebro-Placental Ratio (CPR) &lt;10th centile were compared with those with normal CPR i.e., &gt;10th centile. An adverse obstetric outcome, like foetal distress, meconium aspiration syndrome or respiratory distress syndrome, mode of delivery, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality was analysed in the study population using chi-square test or Fischer’s-exact test. Results: In this study, there was a significant association between foetal distress and CPR with Odds Ratio (OR) of 4.21 i.e., foetal distress was 4.21 times higher in the abnormal group compared to the normal group. Among 20 cases with abnormal CPR, 11 had foetal distress i.e., 55% and among 40 cases with normal CPR, nine had foetal distress i.e., 22.5%. Among those with abnormal CPR, 15% had Amniotic Fluid Index (AFI) &lt;8 and among those with normal CPR, 0% had AFI &lt;8, showing a significant association. Conclusion: In low-risk patients with EFW &gt;10th centile and abnormal CPR, there was a significant association with adverse obstetric outcomes, requiring vigilant intrapartum monitoring.

Colour Doppler and Adverse Perinatal Outcomes in Pregnancies with Foetal Growth Restriction: A Prospective Longitudinal Study

Introduction: Foetal Growth Restriction (FGR) accounts for a significant proportion of perinatal morbidity and mortality. The study was done to diagnose the foetuses “at risk”, so that timely intervention could prevent perinatal morbidity and mortality, as FGR foetuses with deranged velocimetry of Uterine Artery (UA), Umbilical Artery (UMA), Middle Cerebral Arteries (MCA) are associated with high perinatal morbidity and mortality. Aim: To evaluate the usefulness of blood flow velocimetry of UA, UMA, and MCA as well as a Cerebroplacental Ratio (CPR) on colour doppler and their prediction of adverse perinatal outcome. Materials and Methods: This was a prospective longitudinal study done in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from October 2021 to March 2022. The study was conducted among 200 antenatal patients, who had a singleton pregnancy, irrespective of age and parity and had FGR foetuses. Blood flow velocities in the UA, UMA, MCA, and CPR were measured. Patients were divided into four groups with 50 patients in each group. Group I included FGR foetuses with normal blood velocities, group II included FGR foetuses with abnormal UA velocimetry, group III included FGR foetuses with abnormal UMA and MCA velocimetry and group IV included FGR foetuses with abnormal CPR. Adverse perinatal outcomes in the form of Respiratory Distress Syndrome (RDS), prematurity, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) &lt;7 at 5 minutes, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality were assessed in relation to these doppler blood flow patterns. Categorical variables were analysed with the help of Chi-square test and Fisher-exact Test. Continuous variables were analysed with ANOVA when data were normally distributed otherwise Kruskal Wallis H test was used. Results: The mean birth weight was 2432±423, 2209±329, 2100±223 and 1329±403 grams in Groups-I, II, III, and IV (p-value of &lt;0.001.) The mean gestational age was 38.1±2.3, 37.3±3.2, 36±3.6 and 33.1±3.1 weeks in groups I, II, III, and IV (p-value of &lt;0.001). Perinatal morbidity in the form of RDS and prematurity were compared among four groups with 0, 3 (6%), 17 (34%), and 39 (78%) in Groups I, II, III, and IV (p-value of &lt;0.001). APGAR score &lt;7 at 5 minutes was 0, 2 (4%), 9 (18%), and 13 (26%) in groups 1, II, III, and IV (p-value of &lt;0.001). A total of 6 (12%), 16 (32%), 37 (74%) and 46 (92%) C-sections were performed in group I, II, III and IV, respectively, p-value of &lt;0.001. Maternal mortality of 1 (2%) in group III and 2 (4%) was observed in group IV. But no maternal death was there in group I and II. Conclusion: The adverse perinatal outcomes were seen with changes in Pulsatility Index (PI) value of UA, UMA, MCA. But the patients with a deranged CPR ratio had got worse perinatal outcomes than either deranged MCA, PI or UMA PI alone. Hence, doppler ultrasound especially CPR ratio should be an integral component of routine evaluation of FGR pregnancies, as it helps in obstetrical surveillance and management, and thereby improving adverse perinatal outcomes.

Прогнозирование риска неблагоприятных перинатальных исходов у беременных с задержкой роста плода

Objective. Development of additional Doppler criteria for predicting the risk of adverse perinatal outcomes in pregnant women with fetal growth restriction (FGR) Patients and methods. 161 patients with singleton pregnancies were examined: 100 women were diagnosed with АПК, and 31 women had fetuses that were low in weight by gestational age; The control group consisted of 30 patients with normal fetal growth. Ultrasound, in addition to fetometry, included Doppler sonography of blood flow in the uterine arteries, umbilical arteries and the fetal middle cerebral artery. The cerebroplacental ratio (CPR) and cerebro-placental-uterine ratio (CPUR) were determined. Reference values of CPUR in patients with FGR have been developed. Results. The ROC analysis in 100 patients with FGR showed that using of CPUR predict a high risk of adverse perinatal outcomes with a sensitivity of 60% and a specificity of 82%. The positive predictive value of CPUR was 91% (83% for CPR). In pregnant women with severe FGR (&lt;3rd centile), the positive prognostic value was – 97%, the highest values were founded in patients with an early phenotype – 100% (with late – 93%). Conclusion. CPUR has a high prognostic significance in relation to the risk of adverse perinatal outcomes in patients with FGR, which indicates the using this indicator along with CPR in the examination of patients with low fetal weight. Key words: fetal growth restriction, early phenotype, late phenotype, cerebro-placental ratio, cerebro-placental-uterine

Maternal, obstetric, and fetal Doppler characteristics in a high-risk population: prediction of adverse perinatal outcomes and of cesarean section due to intrapartum fetal compromise.

To evaluate the capacity of fetal Doppler, maternal, and obstetric characteristics for the prediction of cesarean section due to intrapartum fetal compromise (IFC), a 5-min Apgar score < 7, and an adverse perinatal outcome (APO), in a high-risk population. This was a prospective cohort study involving 613 singleton pregnant women, admitted for labor induction or at the beginning of spontaneous labor, who underwent Doppler ultrasound within the last 72 h before delivery. The outcome measures were cesarean section due to IFC, a 5-min Apgar score < 7, and any APO. We found that maternal characteristics were neither associated with nor predictors of an APO. Abnormal umbilical artery (UA) resistance index (RI) and the need for intrauterine resuscitation were found to be significant risk factors for cesarean section due to IFC (p = 0.03 and p < 0.0001, respectively). A UA RI > the 95th percentile and a cerebroplacental ratio (CPR) < 0.98 were also found to be predictors of cesarean section due to IFC. Gestational age and a UA RI > 0.84 were found to be predictors of a 5-min Apgar score < 7 for newborns at < 29 and ≥ 29 weeks, respectively. The UA RI and CPR presented moderate accuracy in predicting an APO, with areas under the ROC curve of 0.76 and 0.72, respectively. A high UA RI appears to be a significant predictor of an APO. The CPR seems to be predictive of cesarean section due to IFC and of an APO in late preterm and term newborns.

Prognostic value of the middle cerebral to umbilical artery Doppler ratio in the prediction of outcomes in post-term pregnancy

Objective. To evaluate the diagnostic value of the middle cerebral artery to umbilical artery Doppler ratio (MCA/UA ratio) in predicting poor perinatal outcomes in post-term pregnancies. Patients and methods. This study included patients diagnosed with post-term pregnancy who were admitted to the maternity hospitals in Ain Shams University and Al-Azhar University between January 2019 and December 2021. All patients underwent color Doppler velocimetry and were divided into two groups based on the MCA/UA ratio values: group A (n = 100) – MCA/UA ratio &lt;1, and group B (n = 100) – MCA/UA ratio ≥1. Outcome factors were admission to the neonatal intensive care unit, an Apgar score of less than 7 at 5 minutes, gestational age at delivery, birth weight, and intrauterine growth restriction. Results. The MCA/UA resistance index ratio (MCA-RI/UA-RI) with a cut-off value of 0.88 was found to be the most sensitive parameter in the prediction of adverse prenatal outcomes: sensitivity – 89%, specificity – 71%, positive predictive value (PPV) – 72%, negative predictive value (NPV) – 71%. All parameters combined showed a 93% sensitivity, 92% specificity, 92% PPV, and 89% NPV. Conclusion. To enhance obstetric outcomes and prevent unnecessary treatment and perinatal death, cerebroplacental ratio appears to be a helpful indication in predicting poor neonatal outcomes in post-term pregnancy. Key words: Doppler velocimetry, middle cerebral to umbilical artery ratio, post-term pregnancy

Кардиальная дисфункция у плода: влияние на исходы в перинатальном периоде у недоношенных детей

Objective. To study the importance of fetal cardiac dysfunction in the genesis of perinatal brain damage in premature newborns. Patients and methods. A prospective cohort comparative study included 59 preterm infants with gestational age from 26 to 32 weeks and body weight from 590 to 1990. Newborns were divided into 2 groups at the 1st month of life: the main group (n = 38), which included children with structural brain lesions, and the control group (n = 21) with favorable neurological outcomes. There were no statistically significant differences in either body weight or gestational age between the groups. At the antenatal stage, all underwent ultrasound doppler sonography of uteroplacental blood flow, and the cerebral-placental ratio was calculated. The following markers were determined at the 1st day of postnatal life: levels of lactate, cerebral natriuretic propeptide and soluble type 2 tumor suppressor in the umbilical cord blood of a newborn (enzyme-linked immunosorbent assay); neurosonography of the brain with the determination of blood flow and doppler echocardiography. Neurological outcomes were assessed after 1 month of life after the control neurosonography of brain. The data are presented in the form of median, maximum and minimum values – Me [min; max]. The obtained data were processed using the Statistica 6.1 program. The Mann–Whitney and Fisher χ2 criteria with the Yeats correction were calculated. The differences were considered significant at p equal to 0.05. Results. The pulsation index in the umbilical cord artery was significantly higher (1.270 [1.120; 1.320] versus 0.984 [0.798; 1.120]) in the fetuses of the main group, Its values indicating severe disorders of fetal-placental hemodynamics were more often recorded (in 15–39.5% cases versus 4–19.1%). The significant decrease in the cerebroplacental ratio was significantly more often recorded (in 18–47.4% cases versus 2–9.5%) in the same group. The levels of lactate (3.6 [2.1; 5.2] versus 2.25 [1.3; 3.05] mmol/L) and cerebral natriuretic propeptide (243.2 [84.17; 1385] versus 111.6 [64.8; 2903] pg/ml, respectively) were significantly elevated in the umbilical cord blood, in newborns of the main group. The newborns of the main group had significantly lower levels of systolic, diastolic and mean blood pressure, at the first hours of life. They also had a reduced level of blood flow in the superior vena cava (Me = 65 ml/kg/min; 9 (23.7%) children had a periventricular leukomalacia, 18 (47.4%) – intraventricular hemorrhages of the II–III degree, and 2 (5.3%) had a stroke. Conclusion. It is very important to pay attention of pediatricians-neonatologists to the antenatal period. Treating the fetus as a patient, early assessment of hemodynamics and timely diagnosis of fetal cardiac dysfunction and other developmental abnormalities will reduce the incidence of disabling perinatal diseases and the level of perinatal mortality. Key words: antenatal diagnosis, umbilical cord blood lactate, prematurity, perinatal brain damage, placental insufficiency, fetal cardiac dysfunction

Diagnostic models for the detection of intrauterine growth restriction and placental insufficiency severity based on magnetic resonance imaging of the placenta.

We aimed to provide diagnostic models based on different parameters of placental magnetic resonance imaging (MRI) to detect intrauterine growth restriction (IUGR), as well as the severity of placental insufficiency. We included 44 foetuses with appropriate weight for gestational age (AGA) and 46 foetuses with documented IUGR, defined as the estimated foetal weight (EFW) below the 10th centile. Using Doppler ultrasound, IUGR cases were divided into 2 groups: 1) IUGR with severity signs: EFW < 3rd centile, or cerebroplacental ratio < 5th centile, or abnormal umbilical/uterine artery pulsatility index; and 2) non-severe IUGR without any of this criterion. For all these participants, placental MRI was performed in the third gestational trimester, and its parameters were compared between AGA and IUGR, as well as between the severe and non-severe IUGR groups. Two diagnostic models consisting of significant predictors were developed, and their performance was investigated with accuracy metrics. The severity signs were detected in 25 (54.3%) IUGR cases. The diagnostic model for the differentiation of IUGR from AGA revealed an acceptable performance (area under the curve [AUC] of 0.749) and consisted of 2 variables: 1) the largest size of infarct ≥ 25 mm (odds ratio [OR] = 5.01, p = 0.001), and 2) thickness : volume ratio ≥ 0.043 (OR = 3.76, p = 0.027); while, the logistic regression model for detection of the severity signs was even better, with AUC = 0.862, and comprised of 2 predictors: 1) placental infarct percent ≥ 10% (OR = 26.73, p = 0.004), and 2) placental globular shape (OR = 5.40, p = 0.034). Placental MRI parameters can differentiate IUGR from AGA, and more precisely, assess the severity of placental insufficiency in IUGR foetuses.

Highlighting early detection of thyroid pathology and gestational diabetes effects on oxidative stress that provokes preterm delivery in thyroidology: Does that ring a bell?

ObjectivesAd fontes, the status of the thyroid gland, and metabolic disturbance lead to the alteration of oxygenation. In pregnancy, it is particularly crucial to possess all predictive parameters. MethodsThis cross-sectional study was conducted at the Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia, between 2017 and 2021 which study included a total of 99 women who had been admitted for preterm delivery and had undergone thyroid analysis, detected Hashimoto thyroiditis, and Oral Glucose Tolerance Test (OGTT) 40 days after delivery and had pathological Homeostatic Model Assessment for Insulin Response (HOMA IR) indices. In the group of urgent patients with preterm delivery, we looked after not only routine Doppler of the umbilical artery, but we measured specific ratios such as the Cerebroplacental ratio (CP). ResultsThe mean maternal age was 32.23 ± 5.96 years and the mean gestational age was detected as 35.40 ± 2.39 weeks. The delivery was completed vaginally in 77 women (78%) and surgically in 22 (22%). The Mean APGAR score was 8.44 ± 1.18, the mean birth weight was 2666.87 ± 622.17g and the cases undergoing cesarean section had significantly higher values of pulsatility index (1.85 ± 0.27 vs. 1.34 ± 0.31) and CP (1.22 ± 0.26 vs. 0.47 ± 0.17). ConclusionsThe introduction of Doppler sonography for blood flow assessment helps to form a complete clinical description of the patient, particularly in conditions where oxidative stress became provocative by the thyroid gland antibodies and gestational diabetes in Thyroidology.

Fetal cerebroplacental ratio at term gestation in the prediction of adverse perinatal outcome

Introdction: Assessment of impedance to blood flow in fetal umbilical artery (UA) and middle cerebral artery (MCA) with Doppler ultrasonography is commonly used in surveillance of fetuses at high risk. Although high UA pulsatility index (PI) and low MCA PI, themselves are predictors of adverse perinatal outcome, combining these two parameters calculating the cerebroplacental ratio (CPR) further improves the predictive value. Objective: To find the association between the cerebroplacental ratio and adverse perinatal outcome. Methods: Prospective cohort study conducted in Teaching Hospital, Anuradhapura. 354 singleton pregnancies at 37-41 weeks gestation were included. Ultrasound scanning performed measuring fetal UAPI and MCAPI and CPR was calculated. Fetuses were followed up for intrapartum adverse outcome categorized as NNU admission, perinatal death, fetal distress, Apgar score &lt; 7 at 5 min and any adverse outcome. Descriptive statistics and the statistical applications for diagnostic test accuracy were used for data analysis. ROC curve were plotted to analyze the predictability of CPR for each category. Results: CPR has a significantly positive ability of predicting any type of adverse event. (AUC=0.501-.623, 95%CI) An overall predictability is shown by the other variables used in the study such as MCAPI (AUC=0.505:95%CI=0.444-0.567) and UAPI 0.518 (95% CI=0.457-0.579). But the predictability of CPR value is more superior to the MCAPI and UAPI values. Identified best cut off value for CPR is 0.8533 for predicting adverse events with 80.3% sensitivity. Conclusion: More reliable predictions to detect adverse perinatal outcomes can be achieved by the CPR value than the UAPI and MCAPI values.

Diagnostic Accuracy of Cerebroplacental Ratio in Prediction of Postnatal Outcomes in Oligohydramnios.

The evidence on isolated oligohydramnios (IO) patients and their postnatal outcomes are inconsistent. Recent research has clarified the connection between that IO and negative outcomes in the postnatal period.Our goal was to analyze the correlation between Doppler measurements and postnatal outcomes in oligohydramnios patients, with a focus on the cerebroplacental ratio (CPR). A cohort study was conducted in the Radiology Departmentof Khan Research Laboratories (KRL) Hospitalfrom October 2021 to July 2022. One hundred women were chosen as the sample size. For this study, we used the Raosoft sample size calculator with a 95% confidence interval and a 5% margin of error. Both the middle cerebral artery and the umbilical artery were imaged using ultrasound, and the systolic-to-diastolic ratio and peak systolic velocity are recorded. Pulsatility index(PI) and resistive index (RI) were also calculated. If the amniotic fluid index (AFI) is less than 5 cm, the condition is known as oligohydramnios. The newborn's APGAR score was taken immediately after birth as well as after 5 minutes. We have determined that, on average, mothers are 35.45 weeks/248.15 days pregnant. When compared to the reference standard, CPRdiagnostic features showed a sensitivity of 92% and a specificity of 77.27. Overall diagnostic accuracy is predicted to be 93.0%, with a 93.50% positive prognosis and a 73.91% negative prognosis. The effect size for the change in APGAR scores before and after the test was -2.38 1.03, with a 95% confidence interval of -2.58 to -2.17 and a significance level of 0.00. This study concludes that CPR is an effective screening tool and that it can be used to predict postnatal outcomes in patients with oligohydramnios. Clinical prediction rules were found to be a more effective screening tool, with a sensitivity of 92%, a specificity of 77.27%, and a diagnostic accuracy of 92.3%.

Uteroplacental-Cerebral Ratio: A Doppler Parameter for Prognostic Prediction of Late-Onset Fetal Growth Restriction: Single Center Prospective Cohort Study.

Purpose: This study aimed to elucidate the accuracy of Doppler parameters in predicting the prognosis of late-onset fetal growth restriction (FGR). Methods: This was a prospective study of 114 pregnancies. Doppler parameters, including the cerebroplacental ratio and pulsatility index (PI) in the middle cerebral, umbilical, uterine artery, were recorded. The new uteroplacental−cerebro ratio (UPCR) was constructed as the ratio of (umbilical artery + mean of the left and right uterine artery) to middle cerebral artery PI. Logistic regression analyses and receiver operating characteristic curves were performed. Results: Adverse outcomes occurred in 37 (32%) neonates. The z values of the middle cerebral artery PI and cerebroplacental ratio were lower (p < 0.001), while the z values of the umbilical artery PI, mean uterine artery PI, and UPCR (p < 0.001) were higher in late-onset FGR in those with compared to those without adverse outcomes. Multivariate logistic regression revealed that only UPCR was independently associated with adverse outcomes (p < 0.001). For predicting the prognosis of late-onset FGR, UPCR showed a fair degree of accuracy (area under the curve [AUC], 0.824). Conclusion: The new UPCR, reflecting the impact of placental impedance from both fetal and maternal sides on fetal well-being, improves the accuracy of prognostic prediction for late-onset FGR.

Preterm Birth Rates after Initiating the Third-Trimester Screening Protocol of Samrakshan in India: Initial Results.

Aim To determine the trends in preterm birth (PTB) rates in Samrakshan after initiating a third-trimester screening protocol. Methods The Samrakshan program of IRIA focused on clinical stage-based management of fetal growth restriction (FGR) in the third trimester integrating fetal Doppler studies with routine trimester-specific antenatal scans. Mean uterine artery pulsatility index (PI), umbilical artery PI, middle cerebral artery PI, and cerebroplacental ratio were assessed for all third-trimester pregnant women in the program. Results From 2019 to 2022, 249 (18.33%, 95% CI: 16.34, 20.54) women had PTB with 221 (16.67%, 95% CI: 14.73, 18.75) PTBs between 34 and 37 gestation weeks and 22 (1.66%, 95% CI: 1.10, 2.50) PTBs at gestation < 34 weeks. The overall preterm birth rates showed a significant (chi-square p < 0.001) declining trend each year from 23.18% ( n = 121) in 2019-2020 to 16.81% ( n = 99) in 2020-2021 and 10.75% ( n = 23) in 2021-2022. Conclusion The declining trend of PTB rates in the Samrakshan program shows that the reduction of PTB is an added benefit of the integration of fetal Doppler studies in the third trimester of pregnancy.

Abnormal umbilical artery pulsatility index in appropriately grown fetuses in the early third trimester: an observational cohort study

Objective The aim of this study was to determine if appropriately grown fetuses (those that are not small-for-gestational-age) with a raised umbilical artery pulsatility index (>95th centile) in the early third trimester are at increased risk of placental dysfunction and adverse outcome. Methods This is a 5-year retrospective cohort study using routinely collected data. Inclusion criteria were singleton, non-anomalous pregnancies having a growth scan with umbilical artery Doppler velocimetry between 28 + 0 and 33 + 6 weeks’ gestation. Small-for-gestational-age fetuses were excluded. Cases were classified as group 1 (those with an umbilical artery pulsatility index >95th centile at any scan during target window) or group 2 (those where the umbilical artery pulsatility index was ≤95th centile at all scans). p-Values and odds ratios were calculated. Logistic regression was used to compute odds ratios adjusted for baseline estimated weight z-score, gestational age at delivery, and labor induction. Results After exclusions, there were 202 pregnancies in group 1 and 7950 in group 2. Differences in baseline characteristics between the groups include age (median age was 30 for group 1 and 32 for group 2, p < .001), smoking (group 1 were more likely to smoke, p < .001) and labor induction (more common in group 1, p = .03). Among those delivering ≥34 + 0, group 1 were more likely to be small-for-gestational-age and have an abnormal cerebro-placental ratio at the final scan (OR 6.76, CI 4.23–10.80 and OR 5.07, CI 3.37–7.63 respectively), and to develop features of growth restriction (OR 9.85, CI 6.27–15.49). Group 1 were also more likely to deliver <37 + 0 weeks’ gestation (OR 1.71, CI 1.13–2.58) and to have birthweight <10th or <3rd centile (OR 5.26, CI 3.65–7.58 and OR 6.13, CI 3.00–12.54 respectively). These associations remained significant when adjusted for estimated weight at the initial scan. Conclusions These data suggest that raised umbilical artery pulsatility index in an appropriately grown fetus at 28 + 0 to 33 + 6 weeks’ gestation is associated with subsequent development of growth restriction markers and an increased risk of moderate and severe small-for-gestational-age at birth. This is independent of the estimated weight of these babies at the index scan.