The value of middle cerebral artery and umbilical artery Doppler indices in assessment of fetal well-being and prediction of neonatal outcome in IUGR and preeclampsia

Objective: The objective of this study was to determine the hemodynamic changes in the umbilical artery (UA) and middle cerebral artery (MCA) with oligohydramnios, during third trimester of pregnancy. Materials and Methods: A cross-sectional descriptive study was done in a perinatal ultrasound center, over a 9-month period. The participant sample size was 64, and all of the women were conveniently consented and selected for the study. All individuals were referred for obstetrical sonography in the third trimester, with oligohydramnios. All fetal anomalies, such as a neural tube defect, dwarfism, an abdominal wall defect, were excluded from the study. Results: The mean systolic to diastolic (S/D) ratio for the UA was 3.01, within a range of 1.49 to 5.60 (± 0.79 SD). The mean pulsatility index (PI), of the UA, was 1.11, within a range of 0.41 to 5.51 cm (± 0.64 SD). The mean resistive index (RI) of the UA was 0.66, within a range of 0.33 to 1.25 cm (± 0.13 SD). The mean S/D ratio of the MCA was 5.68, within a range of 2.05 to 26.10 (± 3.10 SD). The mean PI of the MCA was 1.67 within a range of 0.75 to 2.55 cm (± 0.45 SD). The mean resistive index (RI), of the UA, was 0.82 within a range of 0.51 to 1.77 cm (± 0.82 SD). Conclusion: The Doppler indices may rise as pregnancy advances, especially in fetuses with oligohydramnios. In these types of patients, the flow within the MCA may decrease, with an increase in the gestational age. Consequently, it appears that oligohydramnios may lead to vascular remodeling of the UA and MCA.

Download Full-text

The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1683438 ◽

2019 ◽

Vol 37 (05) ◽

pp. 491-496

Author(s):

Ahmed M. Maged ◽

Amira Y. Shoab ◽

Eman A. Hussein ◽

Ahmed H. Alsawaf ◽

Doaa S. Mahmoud ◽

...

Keyword(s):

Cohort Study ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Uterine Artery ◽

Umbilical Artery ◽

Resistance Index ◽

Doppler Measurement ◽

Vaginal Progesterone ◽

Before And After ◽

Doppler Indices

Abstract Objective This study aimed to evaluate the effect of vaginal progesterone (P) administration during the second and third trimesters of pregnancy on Doppler velocimetry of uterine, umbilical, and middle cerebral vessels. Study Design A prospective cohort study conducted on 80 women at risk for preterm labor. Uterine artery, umbilical artery, and middle cerebral artery (MCA) Doppler indices were measured before and after 1 week of administration of 200 mg twice daily vaginal P. The primary outcome parameter was the change of MCA pulsatility index (PI) after P administration. Secondary outcomes included changes in uterine artery and umbilical artery Doppler measurement. Results There was no significant changes of umbilical artery resistance index (RI) (0.69 ± 0.049 vs. 0.68 ± 0.041), umbilical artery PI (1.14 ± 0.118 vs. 1.11 ± 0.116), uterine artery RI (0.66 ± 0.12 vs. 0.66 ± 0.107), uterine artery PI (1.00 ± 0.26 vs. 1.016 ± 0.24), and MCA PI (1.27 ± 0.18 vs. 1.26 ± 0.23) measurements before and after 1 week of P administration, respectively. Conclusion Administration of vaginal P has no significant effects on uterine artery, umbilical artery, and MCA Doppler indices.

Download Full-text

Effects of nifedipine on doppler indices of fetal middle cerebral artery and umbilical artery in managing hypertensive disorders of pregnancy.

Authorea ◽

10.22541/au.158567119.90496032 ◽

2020 ◽

Author(s):

Hillary Kizwi ◽

JianWen Zhu ◽

Mafuru Magesa ◽

Min Wu ◽

Shani Salum

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Umbilical Artery ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Doppler Indices

Download Full-text

Comparative performance of Cerebral Perfusion Ratio as compared to MCA PI and UA PI in prediction of adverse perinatal outcomes in intra uterine growth restricted fetuses

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193113 ◽

2019 ◽

Vol 7 (8) ◽

pp. 2887

Author(s):

Jyotsna S. Shinde ◽

Madan P. Manmohan ◽

Sanjay S. Pasoria ◽

Thahir V. Ummer

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Cerebral Perfusion ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Clinical History ◽

Comparative Performance ◽

Uterine Growth ◽

Adverse Perinatal Outcomes ◽

Doppler Indices

Background: Intra uterine growth restriction (IUGR) is a common clinical sign seen due to chronic foetal hypoxemia and is considered a major contributor of perinatal morbidity and mortality. The aim of the present study was to determine and compare the sensitivity and specificity of umbilical artery pulsatility index (UA PI), middle cerebral artery (MCA) PI and cerebral perfusion ratio (CPR) in predicting adverse and poor perinatal outcomes in fetuses with IUGR.Methods: The study included 100 pregnant women with post 24 weeks of gestation with clinical history of IUGR. Doppler examination parameters, including waveforms and measurements, of the umbilical artery, middle cerebral artery were recorded. The Cerebral Perfusion Ratio (CPR) was calculated from MCA PI and UA PI and a final comparison of accuracy of Doppler indices was done with perinatal outcome.Results: The sensitivity of the UA PI was higher (49.3%) than that of the MCA PI (43.6%) and the CPR (37.7%). The specificity of the CPR was higher (87.1%) than that of the MCA PI (83.9%) and the UA PI (74.2%).Conclusions: From the findings of the study, it can be concluded that UA PI is the most sensitive and CPR is the most specific parameter in predicting adverse perinatal outcomes in IUGR fetuses. Thus, in addition to pulsatility indices, CPR should be used as a tool for surveillance and included in the routine reporting formats of obstetric Doppler studies.

Download Full-text

Role of Umbilical and Middle Cerebral Artery Doppler in Predicting Perinatal Outcome in Cases of Preeclampsia

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/37 ◽

2021 ◽

Vol 8 (04) ◽

pp. 195-198

Author(s):

Kitty Elizabeth Mammen

Keyword(s):

Blood Flow ◽

Birth Weight ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Neonatal Death ◽

Umbilical Artery ◽

Diastolic Flow ◽

Umbilical Artery Doppler

BACKGROUND One of the most common complications of pregnancy is preeclampsia, characterized by abnormal placental development, leading to inadequate uteroplacental blood flow. Doppler ultrasonography can pick up these abnormalities; thus, it is a useful tool to assess fetal outcome. Objective is to calculate the role of colour Doppler (umbilical and middle cerebral artery) in predicting the perinatal outcome. We wanted to evaluate the application of Doppler ultrasound in analysing the blood flow velocity waveform. METHODS This was a cross sectional study carried out between May 2010 - November 2012 in Obstetrics Department, Yenepoya Medical College, Karnataka, among 150 pregnant women with preeclampsia. RESULTS 49.3 % of patients belonged to 25 - 30 years, 58.7 % were primigravida, and 73.3 % and 26.7 % had mild and severe preeclampsia respectively. Patients with increased resistance umbilical artery Doppler - 63.8 % had babies < 2.5 Kg birth weight, 60.9 % Apgar < 7 at 5 minutes of birth and 67.5 % neonatal intensive care unit (NICU) admissions; absent end diastolic flow - all had birth weight < 2 Kg, 90 % Apgar < 7 at 5 minutes, 1 neonatal death and all required NICU admissions; reversal end diastolic flow - 1 neonatal death, all had birth weight < 2.5 Kg, an Apgar < 7 at 5 minutes and required NICU admission. Patients with abnormal Doppler in middle cerebral artery, 46.2 % were low birth weight and had Apgar < 7 at 5 minutes, 50 % required NICU admissions, but no perinatal mortality. CONCLUSIONS Doppler analysis helps in early detection of uteroplacental and fetoplacental changes and to take decisions for early interventions, like administration of steroids for fetal lung maturity and transferring preterm pregnancies to higher centres for better NICU facilities. Umbilical artery Doppler findings are slightly better predictors of adverse perinatal outcome than an abnormal middle cerebral artery. KEYWORDS Doppler, Preeclampsia, Perinatal Outcome, Umbilical Artery, Middle Cerebral Artery

Download Full-text