P220: Middle cerebral artery peak systolic velocity in normal and high risk pregnancies: the impact of Doppler-gate-placement and correction of the angle of insonation

Introduction: The 10th percentile of expected foetal weight for gestational age is classified as intrauterine growth restriction (IUGR) or foetal growth restriction. IUGR occurs for a variety of reasons. Any issue with the placenta is a major contributor. Aims and objectives: 1) To determine the role of ultrasonography in screening high risk mothers for detection of IUGR. 2) To find out the impact of fetal parameters on the extent of IUGR.3) For correlation between sonographic pattern of IUGR and the birth weight. 4) For correlation between doppler parameters and perinatal outcome. Materials and methods: This is a prospective study done over a period of 2 years in Mamata General Hospital (MGH) from Oct 2017 to Oct 2019. Study included 50 pregnant women with high risk factors and clinically suspected IUGR attending for ultrasound examination were subjected to Uterine, Umbilical and Middle cerebral artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria. Results: Reverse, absence or slow end diastolic flow was considered abnormal which was seen in 33 patients. Nine patients had Absent /Reversed end diastolic flow of which, 3 patients had IUD, 4 had Still births, 2 were admitted in NICU with apgar at 1min <7. Middle cerebral artery was abnormal in 10 patients, of which 8 patients had IUGR babies with adverse perinatal outcome. MCA/UA S.D ratio, which was abnormal in 19 patients of which 16 patients had adverse perinatal outcome. Conclusion: Doppler has proven to be more sensitive than other methods of foetal monitoring in recognising fetal compromises early and assisting in the proper time of delivery. Keywords: Ultrasonography, doppler, IUGR.

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The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0399 ◽

2020 ◽

Vol 48 (4) ◽

pp. 317-321

Author(s):

Rodney McLaren ◽

Bharati Kalgi ◽

Chima Ndubizu ◽

Peter Homel ◽

Shoshana Haberman ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Repeated Measures ◽

Adverse Outcome ◽

Perinatal Outcomes ◽

Low Risk ◽

Doppler Velocity ◽

Chronic Hypertension ◽

Adverse Perinatal Outcomes

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

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Middle cerebral artery peak systolic velocity (MCA PSV)—its role as an outcome predictor in fetal growth restriction (FGR)

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2006.10.743 ◽

2006 ◽

Vol 195 (6) ◽

pp. S206

Author(s):

Ozhan Turan ◽

D. Makh ◽

Christopher Harman ◽

Ahmet Baschat

Keyword(s):

Middle Cerebral Artery ◽

Fetal Growth ◽

Cerebral Artery ◽

Fetal Growth Restriction ◽

Peak Systolic Velocity ◽

Growth Restriction ◽

Outcome Predictor

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The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03655-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Homeira Vafaei ◽

Fahimeh Kaveh Baghbahadorani ◽

Nasrin Asadi ◽

Maryam Kasraeian ◽

Azam Faraji ◽

...

Keyword(s):

Pulmonary Artery ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Distress Syndrome ◽

Exposed Group ◽

Doppler Velocity ◽

Corticosteroid Administration ◽

The Impact

Abstract Background Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results. Methods Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted. Results When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not. Conclusions The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.

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Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

Neurology ◽

10.1212/wnl.0000000000011987 ◽

2021 ◽

pp. 10.1212/WNL.0000000000011987

Author(s):

Dominik Lehrieder ◽

Katharina Layer ◽

Hans-Peter Müller ◽

Viktoria Rücker ◽

Jan Kassubek ◽

...

Keyword(s):

Infarct Size ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Randomized Trials ◽

Infarct Volume ◽

Unfavorable Outcome ◽

Inclusion Criteria ◽

Younger Patients ◽

Malignant Infarction ◽

The Impact

ObjectiveTo determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multi-center study.MethodsPatients from the DESTINY-Registry that underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS 4-6. Infarct size was quantified semi-automatically from computed tomography or magnetic resonance imaging before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age≤60y) were predefined.ResultsAmong 140 patients with complete datasets (34% female, mean (SD) age 54 (11) years), 105 (75%) had an unfavorable outcome (mRS > 3). Mean (SD) infarct volume was 238 (63) ml. Multivariable logistic regression identified age (OR 1.08 per 1 year increase; 95%-CI 1.02-1.13; p=0.004), infarct size (OR 1.27 per 10ml increase; 95%-CI 1.12-1.44; p<0.001) and NIHSS (OR 1.10; 95%-CI 1.01-1.20; p=0.030) before hemicraniectomy as independent predictors for unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were more than 258 ml before hemicraniectomy.ConclusionOutcome in MMI strongly depends on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision making concerning hemicraniectomy.

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Doppler Flow Velocity Indices (RI, PI, S/D & PSV) of Fetal Middle Cerebral Artery in Normal Pregnancies: Correlation with Gestational Age of 20 to 40 Weeks

BIRDEM Medical Journal ◽

10.3329/birdem.v2i2.12306 ◽

2012 ◽

Vol 2 (2) ◽

pp. 77-80

Author(s):

Md Abu Taher ◽

Nuzhat Tasmin ◽

AS Mohiuddin ◽

Md Mohit Ul Alam ◽

Md Mofazzal Sharif ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Flow Velocity ◽

Cerebral Artery ◽

Gestational Age ◽

Resistance Index ◽

Peak Systolic Velocity ◽

Doppler Flow ◽

Significant Difference ◽

Before And After ◽

Doppler Indices

This observational type of descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM selecting 70 Bangladeshi pregnant babies with the aim to find out the normogram of foetal middle cerebral artery Doppler flow velocity indices and correlation between Doppler flow velocity indices [Resistance Index (RI), Pulsatility Index (PI), Systolic/Diastolic ratio (S/D) & Peak Systolic Velocity (PSV)] of foetal middle cerebral artery and gestational age in normal pregnancies of 20 to 40 weeks. It was observed that RI, PI and S/D were decreased with the advance of gestational age but PSV was increases with the advance of gestational age. Statistical analyses showed there were significant difference between mean PSV, RI and PI before and after 25 weeks of gestation. No significant difference was found between mean S/D before and after 25 weeks of gestation. It was observed from Correlation analysis between Doppler indices with independent gestational age that all the Doppler indices of foetal middle cerebra artery was positively correlated with the whole gestation period. The statistical analysis showed only PSV and RI were significantly correlated with the gestational age. Simple regression analysis between dependent Doppler index with independent gestational age before and after 25 weeks revealed that all the Doppler indices had positive relationship with the corresponding gestational age but relationship between PSV and PI (before 25 weeks) with their corresponding gestational ages were only statistically significant.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12306 Birdem Med J 2012; 2(2) 77-80

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