Middle Cerebral Artery Doppler Research Articles

A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers

Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student’s t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.

An Unusual Monochorionic Pregnancy.

An Unusual Monochorionic Pregnancy.

Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome.

ObjectivesThe present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome.MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis.ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (p-value <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes.ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.

Case of Hemolytic Disease of the Newborn due to a Rare Red Cell Antibody.

Case of Hemolytic Disease of the Newborn due to a Rare Red Cell Antibody.

OP04.09: Umbilical artery and middle cerebral artery Doppler abnormalities during fetal myelomeningocele repair: drug‐induced waveform changes?

OP04.09: Umbilical artery and middle cerebral artery Doppler abnormalities during fetal myelomeningocele repair: drug‐induced waveform changes?

Serial measurement of soluble endoglin for risk assessment at the diagnosis of fetal growth restriction.

In this study, we aimed to investigate the soluble endoglin (sEng) levels in pregnant women with fetal growth restriction (FGR) and to examine the possible relation of the sEng levels with the time remaining to delivery and maternal and fetal complications. A total of 42 pregnant women diagnosed with FGR were retrospectively reviewed. Using the maternal blood samples it is at the collected 24-37 gestational weeks, the sEng levels were measured. Fetal biometry measurements, umbilical artery, uterine artery, middle cerebral artery Doppler indices were documented. Of all patients, 17 (40%) were diagnosed with early-onset FGR, while 25 (60%) were diagnosed with late-onset FGR. Abnormal Doppler findings were present in 25 (60%) patients. Of 42 newborns, 18 (42%) were hospitalised in the neonatal unit. The mean sEng level calculated by taking the average of the first and second blood samples was 63.24±49.83ng/mL. There was no statistically significant difference in the mean sEng levels between those who gave birth within four, three, and two weeks after the diagnosis of FGR and those who did not. There was a positive significant correlation between the mean sEng levels and systolic blood pressure (r=0.319, P=.04). We did not find a statistically significant relationship between the sEng level and the time remaining to the time of delivery in pregnant women with FGR. We found no statistically significant difference in sEng level between the groups in pregnant women with fetuses with FGR with or without maternal and fetal complications.

Performance of middle cerebral artery doppler for prediction of recurrent fetal anemia

Objective To assess the predictive value of middle cerebral artery Doppler peak systolic velocity (MCA-PSV) for moderate-severe fetal anemia following one intrauterine transfusion (IUT) and test the performance of alternate cutoffs to the recommended threshold ≥1.69 multiples of the median (MoM). Methods This was a retrospective cohort study of patients with pregnancies affected by alloimmunization who underwent percutaneous umbilical blood sampling (PUBS) procedures from 2000 to 2020. An MCA-PSV ≥1.69 MoM was the indication for the second IUT. The primary outcome was recurrent moderate-severe fetal anemia. Receiver-operating characteristic (ROC) curves assessed the predictive ability of MCA-PSV for the primary outcome and the Youden index identified the “optimal” cutoff value. Predictive characteristics of MCA-PSV ≥1.69 MoM and the “optimal” cutoff were compared. Results Of the 58 patients who underwent IUT during the study period, 36 (62%) did not meet inclusion criteria. Of the remaining 22 patients who underwent a second PUBS, 12 (54.6%) fetuses had moderate or severe anemia. Following one IUT, the AUC for MCA-PSV was 0.86 (95% CI 0.70–1.00) for the primary outcome. The “optimal” cutoff MCA-PSV value was 1.74 MoM, which had a greater specificity than ≥1.69 MoM (90 vs. 50%, p = .05), but was not statistically significant. The sensitivity was similar between the two cutoff values of ≥1.69 and ≥1.74 MoM (83.3 vs. 75.0%, p = .65) (Table 2). Conclusion Raising the recommended MCA-PSV cutoff to ≥1.74 MoM for recurrent moderate-severe fetal anemia after one IUT would decrease the number of unnecessary procedures without significantly changing the sensitivity of this screening test.

Correlation of Doppler Findings with Perinatal Outcome Among Patients with Pregnancy Induced Hypertension

Background: Hypertensive conditions are the most widely recognized medical complications during pregnancy. Aims and Objectives: In the current study, an attempt was made to understand the significance of Doppler studies in pregnancy induced hypertension and to correlate with the perinatal outcome and to offer better strategies of prevention and early detection and management. Methods: The study comprised of 138 patients admitted in a tertiary care centre at or beyond 28 weeks of gestation with pregnancy induced hypertension (PIH). To determine and monitor a favorable or worsening fetal wellbeing status, follow up Doppler studies were performed though the results of only last Doppler ultrasound within one week of delivery were used for analysis. Patients were followed up till delivery. The maternal and perinatal outcome was studied thereafter. Results: Umbilical Artery (UA) Doppler findings disclosed 26.8% had abnormal umbilical artery S/D ratio, 31.1% had abnormal umbilical artery Recoiling Index (RI) and 2.90% had abnormal umbilical artery Pulsatality Index (PI). Perinatal mortality in the abnormal umbilical artery PI category was found to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%)to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%) and umbilical artery RI ratio (66.7%). In the estimation of adverse perinatal outcome, the predictive accuracy of the umbilical artery S/D ratio in the prediction of adverse perinatal outcome was found to be 73.91%while that of UA RI ratio was 68.12% and the UA PI was 61.59%.Itwas found that in prediction of adverse perinatal outcome, the Umbilical artery PI had higher specificity (97.65%) than the UA S/D ratio (88.24%) and UA RI (80.00%). Fetal middle cerebral artery Doppler studies revealed that 15.2% patients had abnormal MCA S/D ratio, 13.0% had abnormal MCA RI and 15.21% had abnormal MCA PI of which maximum perinatal mortality was seen in abnormal MCA S/D ratio (66.7%) followed by MCA PI (33.3%). Most specific predictor of adverse perinatal outcome was Cerebroplacental ratio (MCA PI/UA PI be (97.65%) The cerebroplacental index has the highest specificity (97.65%)and positive predictive value (93.55%) in predicting adverse perinatal outcome, compared to that of Umbilical artery pusatility index (97.65% and 1.60%) and MCA Pulsatility Index (91.76 and 84.62%) in the present study. Conclusion: The present study noted the prominance of Doppler ultrasound studies in PIH patients, detecting compromised fetuses in utero and taking fitting action in a timely manner.In the present study, the predictive accuracy of the umbilical artery S/D ratio in predicting adverse perinatal outcome was found to be high relative to UA RI and UA PI. In addition, the umbilical artery PI had the highest specificity compared to other Doppler parameters. Absent end diastolic flow and Reversal of end diastolicflow were associated with significant perinatal.

Short-Term Effects of Dexamethasone versus Betamethasone on Ultrasonic Measures of Fetal Well-Being: Cohort from a Blinded, Randomized Trial

Introduction: Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. Methods: Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. Results: Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012–2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight <10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15–20%, and average BPP decreased slightly on days 1–2. There were no major differential effects of dexamethasone versus betamethasone. Discussion/Conclusion: No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.

The role of the brain-sparing effect of growth-restricted fetuses in newborn germinal matrix/intraventricular hemorrhage.

The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH). A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome. The rate of Grade I-II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome. Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

Predicting Adverse Outcomes in Monochorionic-Diamniotic Twins: The Role of Intertwin Discrepancy in Middle Cerebral Artery Doppler Measurements and the Cerebroplacental Ratio.

This study was aimed to evaluate the role of intertwin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) and cerebroplacental ratio (CPR) for the prediction of adverse outcomes in monochorionic-diamniotic (MCDA) twin pregnancies. A retrospective cohort study of MCDA pregnancies that underwent ultrasound surveillance at a perinatal referral center from 2007 to 2017. Intertwin MCA-PSV discrepancy (MCA-ΔPSV-MoM) was defined as the absolute difference of MCA-PSV multiple of the median (MoM) for gestational age between twins. Intertwin CPR discrepancy (CPR-Δ) was defined as the absolute difference of CPR between twins. The maximum MCA-ΔPSV-MoM and CPR-Δ before and after 26 weeks of gestation were assessed as predictors of pregnancy and neonatal outcomes through simple logistic regression models and Pearson's correlation coefficients. Receiver operating characteristic (ROC) curves were generated to determine the predictive value of maximum MCA-ΔPSV-MoM and CPR-Δ. A total of 143 MCDA pregnancies met inclusion criteria. There was a significant association between MCA-ΔPSV-MoM at <26 weeks and the development of twin anemia-polycythemia sequence (TAPS; p = 0.007), intrauterine fetal demise (IUFD; p = 0.009), and neonatal intensive care unit (NICU) admission (p < 0.05). MCA-ΔPSV-MoM at ≥26 weeks was associated with the development of TAPS (p < 0.001). CPR-Δ at <26 weeks was associated with the development of twin-twin transfusion syndrome (TTTS; p = 0.03) and NICU admission (p = 0.02). MCA-ΔPSV-MoM at ≥26 weeks was highly predictive of TAPS (area under curve [AUC] = 0.92). A cut-off of 0.44 would identify TAPS with 100% sensitivity and 73% specificity. In MCDA pregnancies, intertwin MCA and CPR discrepancies are associated with adverse pregnancy and neonatal outcomes, including TAPS, TTTS, IUFD, and NICU admission. Evaluation of intertwin MCA and CPR differences demonstrated the potential for clinical predictive utility in the surveillance of MCDA twin pregnancies. · Intertwin discrepancy of MCA-PSV and CPR is associated with adverse pregnancy outcomes.. · Intertwin differences in Doppler ultrasound may occur prior to meeting diagnostic criteria for TTTS or TAPS.. · There is potential clinical predictive utility in MCA and CPR surveillance of MCDA twin pregnancies..

Prenatal cerebellar growth is altered in congenital diaphragmatic hernia on ultrasound.

Children with congenital diaphragmatic hernia (CDH) are at risk for neurodevelopmental delay. Herein we report on prenatal changes in biometry and brain perfusion in fetuses with isolated CDH. This retrospective study evaluated fetuses with isolated, left-sided CDH in three European referral centers. Abdominal circumference (AC), femur length (FL), head circumference (HC), transcerebellar diameter (TCD), middle cerebral artery (MCA) Doppler, and ventricular width (VW) were assessed during four gestational periods (<24weeks, 25-28weeks, 29-32weeks, >33weeks). Z-scores were calculated, and growth curves were created based on longitudinal data. In 367 fetuses, HC, AC and FL were within normal ranges throughout gestation. The TCD diminished with advancing gestational age to fall below the fifth percentile after 32weeks. A less pronounced but similar trend was seen in VW. The peak systolic velocity of the MCA was consistently approximately 10% lower than normal. Disease severity was correlated to TCD (p=0.002) and MCA doppler values (p=0.002). There were no differences between fetuses treated with FETO and those managed expectantly. Fetuses with isolated left-sided CDH have a small cerebellum and reduced MCA peak systolic velocity. Follow up studies are necessary to determine the impact of these changes on neurodevelopment.

ROLE OF ULTRASOUND AND COLOR FLOW DOPPLER IN DIAGNOSIS OF INTRAUTERINE GROWTH RESTRICTION

BACKGROUND: Multi-vessel Doppler ultrasonography is the principal surveillance tools in pregnancies complicated by fetal growth restriction. OBJECTIVE:To determine diagnostic accuracy of the fetal umbilical artery, middle cerebral artery pulsatility indices and their ratio in intrauterine growth restricted fetuses. PATIENTS and METHODS: Forty patients were studied that had been diagnosed clinically and ultrasonographically as intra-uterine growth restriction (IUGR). All patients in the study underwent uniform antenatal assessment protocol that includes umbilical artery (UA) and middle cerebral artery (MCA) Doppler ultrasound studies. These were conducted either twice weekly or daily according to the severity of the condition. RESULTS: Abnormal UA PI was found in 25 cases, 11cases due to maternal cause , 5 cases due to placental cause , 9 cases with idiopathic cause of the IUGR group . Abnormal MCA PI was found in 26 cases,11 cases due to maternal cause , 5 cases due to placental cause , 10 cases with idiopathic cause of the IUGR group. Abnormal C/U Ratio was found in 24 cases,11 cases due to maternal cause, 5 cases due to placental cause , 8 cases with idiopathic cause of the IUGR group . CONCLUSION: Among the Doppler indices, the C/U ratio is a better predictor of IUGR fetuses than either the UAPI or the MCA PI alone, with a high specificity and PPV. However, measurement of the UAPI (among all the Doppler indices) is enough to detect IUGR per se, probably because UAPI is a direct reflection of the resistance in the placental vascular bed.

Influence of Cerebral Vasodilation on Blood Reelin Levels in Growth Restricted Fetuses.

Fetal growth restriction (FGR) is one of the most important obstetric pathologies. It is frequently caused by placental insufficiency. Previous studies have shown a relationship between FGR and impaired new-born neurodevelopment, although the molecular mechanisms involved in this association have not yet been completely clarified. Reelin is an extracellular matrix glycoprotein involved in development of neocortex, hippocampus, cerebellum and spinal cord. Reelin has been demonstrated to play a key role in regulating perinatal neurodevelopment and to contribute to the emergence and development of various psychiatric pathologies, and its levels are highly influenced by pathological conditions of hypoxia. The purpose of this article is to study whether reelin levels in new-borns vary as a function of severity of fetal growth restriction by gestational age and sex. We sub-grouped fetuses in: normal weight group (Group 1, n = 17), FGR group with normal umbilical artery Doppler and cerebral redistribution at middle cerebral artery Doppler (Group 2, n = 9), and FGR with abnormal umbilical artery Doppler (Group 3, n = 8). Our results show a significant association of elevated Reelin levels in FGR fetuses with cerebral blood redistribution compared to the normal weight group and the FGR with abnormal umbilical artery group. Future research should focus on further expanding the knowledge of the relationship of reelin and its regulated products with neurodevelopment impairment in new-borns with FGR and should include larger and more homogeneous samples and the combined use of different in vivo techniques in neonates with impaired growth during their different adaptive phases.

Diagnosis and management of fetal growth restriction: the ISUOG guideline and comparison with the SMFM guideline.

Diagnosis and management of fetal growth restriction: the ISUOG guideline and comparison with the SMFM guideline.

Use of the Renal Artery Doppler to Identify Small for Gestational Age Fetuses at Risk for Adverse Neonatal Outcomes.

Objective: To measure the sensitivity and positive predictive value (PPV) for an adverse neonatal outcome among growth-restricted fetuses (FGR) comparing the cerebral–placental ratio (CPR) with the cerebral–renal ratio (CRR). Methods: Retrospective analysis of 92 women who underwent prenatal ultrasound at the University of Maryland and the University of Padua. Renal, middle cerebral and umbilical artery Doppler waveforms were recorded for all scans during the third trimester. The last scan prior to delivery was included for analysis. We calculated the test characteristics of the pulsatility indices (PI) of the umbilical and renal arteries in addition to the derived CPR and CRR to detect a composite adverse neonatal outcome. Results: The test characteristics of the four Doppler ratios to detect increased risk for the composite neonatal outcome demonstrated that the umbilical artery pulsatility index had the best test performance (sensitivity 64% (95% CI: 47–82%), PPV 24% (95% CI: 21–27), and positive likelihood ratio 2.7 (95% CI: 1.4–5.2)). There was no benefit to using the CRR compared with the CPR. The agreement between tests was moderate to poor (Kappa value CPR compared with CRR: 0.5 (95%CI 0.4–0.70), renal artery PI:−0.1 (95% CI −0.2–0.0), umbilical artery PI: 0.5 (95% CI 0.4–0.7)). Only the umbilical artery had an area under the receiver operating curve that was significantly better compared with the CPR as a reference (p-value < 0.01). Conclusions: The data that we present do not support the use of renal artery Doppler as a useful clinical test to identify a fetus at risk for an adverse neonatal outcome. Within the various indices applied to this population, umbilical artery Doppler performed the best in identifying the fetuses at risk for an adverse perinatal outcome.

Doppler studies of placental function

Placental-associated diseases account for most cases of adverse perinatal outcome in developing countries. Doppler evaluation has been incorporated as a predictive parameter at early pregnancy for high-risk placental disease, in the diagnosis and management of those fetuses with impaired intrauterine growth and for the evaluation of fetal wellbeing in those high-risk pregnancies.Uterine Doppler at second trimester predicts most instances of early-onset preeclampsia and intrauterine growth restriction. However, the growing evidence of an effective early propylactic strategy, has turned Uterine Doppler an essential parameter to be included in first trimester predictive algorithms. Umbilical artery Doppler helps in the identification of small-for-gestational-age fetuses at higher risk, and is one of the essential vessels in the assessment of fetal hypoxia impairment, especially in the early cases. It helps in the decision timing for ending the pregnancy improving thus perinatal outcomes. Moreover, in high-risk pregnancies, umbilical artery Doppler has demonstrated to reduce the risk of perinatal deaths and the risk of obstetric interventions. On the other hand, middle cerebral artery Doppler reflects fetal adaptation to hypoxia, and with the cerebroplacental ratio, they improve the detection of fetuses a high risk of adverse perinatal outcome, mostly of those late small fetuses, where most instances of adverse outcome occur in fetuses with normal umbilical artery. Ductus venosous Doppler waveform is a surrogate parameter of the fetal base-acid status. Its use has demonstrated to improve perinatal outcomes, mainly reducing the risk of fetal intrauterine death. Alone or in combination with computerized CTG, it helps tailoring the best moment to end the pregnancy among early cases.

ROLE OF MIDDLE CEREBRAL ARTERY AND DUCTUSVENOSUS DOPPLER IN EVALUATION OF INTRAUTERINE GROWTH RESTRICTION

Background: World over, intrauterine growth restriction (IUGR) is observed in about 24% of newborns. Approximately, 30 million infants suffer from IUGR every year. IUGR is associated with stillbirth, neonatal death, and perinatal morbidity as well as delayed effects including cerebral palsy (CP) and adult diseases. Objective: To assess the role of umbilical artery, middle cerebral artery and ductus venosus doppler in evaluating the neonatal outcome of growth restricted fetuses. Patients and methods: Our study was conducted on 100 pregnant women attended at the department of Obstetrics and Gynecology, Al-Azhr University Hospitals from January 2019 to December 2019. The cases were allocated into 2 main groups: Group I: thirty two pregnant women with intrauterine growth restriction (IUGR), Group II: sixty eight normal pregnant women without IUGR. Results: The presence of high statistical significance correlation between neonatal outcome and Doppler indices of umbilical artery, middle cerebral artery (PSV, PI, RI) in IUGR group. There were also high statistical significance correlation between neonatal outcome and Ductus venosus Doppler with high specificity and sensitivity of A wave RI, PI in IUGR group. Conclusion: The umbilical artery Doppler indices (RI, PI) were abnormally high in IUGR, in addition with S/D ratio have significant relation with poor neonatal outcome in IUGR fetuses. Middle cerebral artery Doppler indices (PSV, S/D ratio, RI and PI) are abnormally high in IUGR and have high significant relation with poor neonatal outcome in IUGR group.

ROLE OF MIDDLE CEREBRAL ARTERY DOPPLER AND AMNIOTIC FLUID INDEX IN PREDICTING PERINATAL OUTCOME IN POSTDATED PREGNANCIES

Background: Post-date pregnancy carries many fold problems for both pregnancy and fetal outcome. Abnormal middle cerebral artery Dopplers are strongly associated with preterm delivery and antenatal steroid administration. Objective: To identify the relationship between middle cerebral artery Doppler, Amniotic fluid index and perinatal outcomes in postdated pregnancies. Patients and Methods: This study was performed on 50 pregnant women whose gestational age was 40–42 weeks’ gestation attending the antenatal clinic of Zefta General Hospital. The study was done during the period between December 2017 and August 2019.Inclusion criteria included singleton living fetuses with vertex presentation in postdated pregnancies (40 – 42) week gestation. Exclusion criteria included cases with premature rupture of membranes, antepartum hemorrhage and maternal medical disorders as hypertension, diabetes mellitus, hepatic, cardiac, renal or anemia with pregnancy, patients with uterine scar. All patients were subjected to detailed history taking, physical examination and routine investigations including complete blood picture, Rh typing, fasting blood sugar, liver functions, kidney functions and urine analysis. Ultrasound and Doppler study were done twice weekly till the onset of labor or termination of pregnancy in order to assess GA, estimated fetal weight (EFW), placental site and grading, amniotic fluid volume (AFV) (oligohydramnios was diagnosed if the largest vertical pocket less than 2 cm), Doppler study of the MCA. The study population was divided into two groups based on the presence or absence of adverse perinatal outcome. Results: Expected fetal weight (EFW), resistive Index of middle cerebral artery (MCA) and resistive Index of umbilical artery (UA) were not significantly predicting perinatal outcome of postdated pregnancies among the studied pregnant women. Amniotic fluid index (AFI) and biophysical profile (BPP) were significant predictors for perinatal outcome of postdated pregnancies. Conclusion: Resistive Index of (MCA) was not significant predictor for perinatal outcome of postdated pregnancies. Amniotic fluid index was significant predictor for perinatal outcome of postdated pregnancies.

Intra-observer variability of Doppler measurements in umbilical artery (UA) and middle cerebral artery (MCA) in uncomplicated term pregnancies

Objective To evaluate the intra-observer variability of the middle cerebral artery (MCA) and umbilical artery (UA) Doppler measurement taken under optimal conditions in term, uncomplicated pregnancies. Methods A prospective study on uncomplicated singleton term pregnancies was performed. Multiple Doppler measurements were taken in the MCA and the UA by one examiner. Intra-rater agreement was calculated. Doppler indices were correlated to fetal biometric parameters and to gestational age. Results One hundred patients were recruited. MCA indices were found to have the highest strength of intra-rater/observer agreement (K = 0.888) versus only a “good” agreement for UA pulsatility index (PI) (K = 0.755).The MCA-PI was significantly correlated with BPD (r = −0.198, p = .047), EFW (r = −0.241, p = .01) and birthweight (r = −0.208, p = .03). A statistically significant decrease was found in the MCA PI (r = −.422, p < .001) and in the CPR (r = −0.444, p < .001) with advancing pregnancy, between 37 and 42 weeks gestation. The UA PI did not change significantly (p = .099) during this period. Conclusions MCA PI measured at term is reproducible with a high ICC. MCA PI significantly decreases with advancing gestation at term. No correlation was found between Doppler measurements and time to delivery.