Cerebroplacental ratio and aortic isthmus Doppler in early fetal growth restriction

AbstractBackgroundAs conflicting results have been reported about the association of reversed flow on the aortic isthmus (AoI) and adverse perinatal results in fetal growth restriction (FGR), we aim to compare perinatal outcomes (including tolerance to labor induction) of late-onset FGR between those with anterograde and reversed AoI flow.MethodsThis was an observational retrospective cohort study on 148 singleton gestations diagnosed with late-onset FGR (diagnosis ≥32+0 weeks), with an estimated fetal weight (EFW) <10thcentile and mild fetal Doppler alteration: umbilical artery (UA) pulsatility index (PI) >95thcentile, middle cerebral artery (MCA)-PI <5thcentile or cerebral-placental ratio <5thcentile. Anterograde AoI flow was present in n=79 and reversed AoI flow in n=69. Delivery was recommended from 37 weeks in both groups. Perinatal results were compared between the groups.ResultsThe global percentage of vaginal delivery of fetuses with anterograde and reversed blood flow was 55.7% vs. 66.7% (P=0.18) and the percentage of cesarean section (C-section) for non-reassuring fetal status was 12.7% vs. 15.9% (P=0.29), respectively. When evaluating those that underwent labor induction, the vaginal delivery rate was 67.9% vs. 77.2% (P=0.17), respectively. There were no significant differences regarding any other perinatal variables and there were no cases of severe morbidity or mortality.ConclusionWe observed that the presence of reversed AoI flow does not worsen perinatal outcomes on fetuses with late-onset growth restriction with mild Doppler alterations. Attempt of labor induction is feasible in these fetuses regardless of the direction of AoI flow.

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Circulating C19MC MicroRNAs in Preeclampsia, Gestational Hypertension, and Fetal Growth Restriction

Mediators of Inflammation ◽

10.1155/2013/186041 ◽

2013 ◽

Vol 2013 ◽

pp. 1-12 ◽

Cited By ~ 41

Author(s):

Ilona Hromadnikova ◽

Katerina Kotlabova ◽

Marketa Ondrackova ◽

Andrea Kestlerova ◽

Veronika Novotna ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Perinatal Outcome ◽

Pulsatility Index ◽

Gestational Hypertension ◽

Clinical Signs ◽

Growth Restriction ◽

Cerebroplacental Ratio ◽

Severity Of The Disease ◽

Ultrasound Parameters

The objective of the study was to identify the profile of circulating C19MC microRNAs (miR-516-5p, miR-517*, miR-518b, miR-520a*, miR-520h, miR-525, and miR-526a) in patients with established preeclampsia (n=63), fetal growth restriction (n=27), and gestational hypertension (n=23). We examined the correlation between plasmatic concentrations and expression levels of microRNAs and the severity of the disease with respect to clinical signs, requirements for the delivery, and Doppler ultrasound parameters. Using absolute and relative quantification approaches, increased extracellular C19MC microRNA levels (miR-516-5p,P=0.037,P=0.009; miR-517*,P=0.033,P=0.043; miR-520a*,P=0.001,P=0.009; miR-525,P=0.026,P=0.01; miR-526a,P=0.03,P=0.035) were detected in patients with preeclampsia. The association analysis pointed to no relationship between C19MC microRNA plasmatic concentrations and expression profile and identified risk factors for a poorer perinatal outcome. However, the dependence between the levels of plasmatic C19MC microRNAs and the pulsatility index in the middle cerebral artery and the values of cerebroplacental ratio was demonstrated. The study brought the interesting finding that the upregulation of miR-516-5p, miR-517*, miR-520a*, miR-525, and miR-526a is a characteristic phenomenon of established preeclampsia.

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Задержка (замедление) роста плода: современные принципы диагностики, классификации и динамического наблюдения

Ultrasound & Functional Diagnostics ◽

10.24835/1607-0771-2019-2-33-44 ◽

2019 ◽

pp. 33-44

Keyword(s):

Doppler Ultrasound ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Uterine Artery ◽

Umbilical Artery ◽

Placental Insufficiency ◽

Growth Restriction ◽

Ductus Venosus ◽

Cerebroplacental Ratio

В статье детально представлены унифицированные критерии диагностики задержки (замедления) роста плода, выработанные в 2016 г. ведущими мировыми экспертами и рекомендованные к применению в клинической и научной работе. Обсуждается современный подход к анализу допплерометрических параметров кровотока в системе “мать-плацентаплод”, включая расчет церебральноплацентар ного отношения. Приводятся международные принципы обследования беременных с задержкой роста плода, протоколы и алгоритмы дальнейшего наблюдения, выбора срока и метода родоразрешения, разработанные на основании доказательных многоцентровых европейских исследований. Ключевые слова: задержка (замедление) роста плода, церебрально-плацентарное отношение, артерия пуповины, маточная артерия, венозный проток, плацентарная недостаточность, ультразвуковое допплеровское исследование, fetal growth restriction, cerebroplacental ratio, umbilical artery, uterine artery, ductus venosus, placental insufficiency, Doppler ultrasound

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Cerebroplacental Ratio as a Predictor of Fetal Growth Restriction and Perinatal Outcome in Women with Hypertensive Disorder in Pregnancy: A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47801.15307 ◽

2021 ◽

Author(s):

Upma Saxena ◽

. Alka

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Perinatal Outcome ◽

Fetal Distress ◽

Growth Restriction ◽

P Value ◽

Singleton Pregnancy ◽

Adverse Perinatal Outcome ◽

Cerebroplacental Ratio ◽

Nicu Admission

Introduction: Hypertensive Disorders in Pregnancy (HDP), is a common complication of pregnancy leading to majority of adverse perinatal outcome. The timely diagnosis of fetal compromise, before irreversible damage, is possible by doing Cerebroplacental Ratio (CPR), on doppler ultrasonography. CPR is calculated as ratio of Pulsatility Index (PI) of Middle cerebral Artery and Umblical Artery (UA). It reflects both the circulatory insufficiency in UA along with adaptive changes in Middle cerebral Artery (MCA). Aim: To evaluate role of Cerebroplacental Ratio as predictor of Fetal Growth Restriction and perinatal outcome in singleton pregnancy with HDP at 28-41 weeks of gestation. Materials and Methods: A prospective observational cohort study was carried out in the Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. The study included 150 women with singleton pregnancy, HDP and 28-41 weeks of gestation. Doppler ultrasound was performed and CPR calculated as ratio of MCA PI and UA PI, using ultrasound study performed within two weeks of delivery. All women were followed-up till delivery and perinatal outcome i.e., birth weight, preterm birth, cesarean for fetal distress, Meconium Stained Liquor (MSL) , APGAR at 5 minutes, still birth, Neonatal Intensive Care Unit (NICU) admission and early neonatal death, were recorded. The data entry was done in the Microsoft excel spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Out of 150 women, 20% (30) had abnormal CPR. Abnormal CPR had significant association with Low Birth Weight (LBW) (p-value=0.0001), preterm delivery (p-value=0.0001), fetal distress (p-value=0.0001), caesarean for fetal distress (p-value=0.0001), 5-minute APGAR score <7 (p-value=0.0001), NICU admission (p-value=0.0001), Meconium Stained Liquor (MSL) (p-value=0.0001) and neonatal death (p-value=0.025). CPR had 100% sensitivity and 100% Negative Predictive Value (NPV) for predicting adverse perinatal outcome with diagnostic accuracy of 47.33%. Conclusion: The CPR is an independent predictor of Fetal Growth Restriction (FGR) in women with HDP. It can also independently predict perinatal outcome in women with HDP with or without FGR. Abnormal CPR had 100% sensitivity for identifying women with high risk of adverse perinatal outcomes, whereas normal CPR, with NPV of 100%, almost excludes it.

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