Fetal umbilical artery to middle cerebral artery doppler velocimetry ratio as a predictor for adverse perinatal outcome in high risk pregnancy

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of <28 weeks to >35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.

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The study of arterial and venous Doppler in high risk pregnancies and its role in perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180904 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1116

Author(s):

S. Tabitha ◽

Madishetti Rajini

Keyword(s):

Birth Weight ◽

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Predictive Value ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Ductus Venosus ◽

Delivery Mode ◽

Care Hospital

Background: Antepartum foetal surveillance is the corner stone in the management of high risk pregnancies, aimed at reducing maternal and perinatal mortality and morbidity. This study was conducted to analyse the blood flow in umbilical artery, middle cerebral artery, umbilical vein and ductus venous using doppler ultrasound in high risk pregnancies.Methods: This was a prospective study conducted in pregnant patients with high risk factors after 28 weeks of gestation who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Hyderabad during the period from October 2013 to December 2014.Results: Patients were divided into two groups, first with normal Doppler and second with abnormal Doppler, containing 76 and 20 patients respectively. Group 2 is again 4 sub-groups according to the vessel affected. Group A included the cases with affected umbilical artery, Group B included the cases with affected middle cerebral artery, Group C included the cases with both affected umbilical artery and middle cerebral artery (UA+MCA), Group D included the Cases with the affected umbilical artery, middle cerebral artery and Ductus Venosus (UA+MCA+DV) containing 12, 2, 4 and 2 patients respectively. There were more number of emergency caesarean sections than vaginal deliveries which is statistically significant (p <0.034), there were more number of sick babies than healthy babies and there are more number of still births which is statistically significant (p <0.0001), there are more number of low birth weight babies in comparison to normal weight, which is statistically significant (p <0.0037). Distribution of cases with abnormal Doppler depending on vessel abnormality according to gestational age at the time of delivery, mode of delivery, perinatal outcome, birth weight, which was statistically significant. The sensitivity and specificity of abnormal Doppler in predicting perinatal outcome is 45% with (95% CI 26.9-64.0) and 89.5% with (95% CI 79.0-95.3) respectively. The positive predictive value is 65% with (95% CI 40.9-83.6) and negative predictive value is 78.9% with (95% CI 67.7-87.1).Conclusions: This study recommends that all high risk pregnant women should undergo serial foetal monitoring. When doppler abnormalities are detected, delivery should be conducted at a tertiary care centre where facilities for caesarean section and NICU are present.

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Correlation of efficacy of cerebro placental ratio with adverse perinatal outcome in clinically suspected IUGR pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181907 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1808

Author(s):

Geeta Singh ◽

Neerja Gupta ◽

Sangeeta Singhal ◽

Pramod Kishor Sharma

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Pulsatility Index ◽

Umbilical Artery ◽

Doppler Velocity ◽

Wave Form ◽

Adverse Perinatal Outcome ◽

Diastolic Flow ◽

Ultrasound Evaluation

Background: IUGR is a most common and complex problem in modern obstetrics. Most commonly use methods to assess fetal condition are BPP and NST which are not sensitive for predicting better perinatal outcome. Present study was an effort to evaluate the role of ratio of pulsatility index (PI) of middle cerebral artery and umbilical artery which is called cerebro placental ratio as the most sensitive, specific and accurate predictor of adverse perinatal outcome in clinically suspected IUGR Pregnancies.Methods: 50 clinically suspected IUGR Pregnancies attending antenatal clinics Muzaffarnagar Medical College and Hospital, Muzaffarnagar were subjected to Doppler ultrasound evaluation Doppler velocity wave form of umbilical artery and fetal middle cerebral artery were obtained. Pulsatility index ratio of MCA and umbilical artery (cerebro placental ratio) was evaluated in each case. Abnormal ratio is defined as CPR<1.08 considered as cut of value. Ratio was coo related clinically with perinatal outcome.Results: Out of 50 antenatal cases, 63% neonates had birth weight <2.5 kg. There were 6 IUD’S and 44 live births, 9 neonates were admitted to NICU, 7 neonates had 5 min. APGAR score <7 and 13 neonates were born by emergency CS. Of the 6 IUDS, 4 cases had reversal of blood flow umbilical artery and 2 cases had absent diastolic flow. In all cases of reversal Diastolic flow, IUD occurred within 7 days of diagnosis. Conclusions: CPR is the most sensitive, specific and accurate parameter in prediction of adverse perinatal outcome and thus can help in decreasing perinatal mortality.

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Fetal pulmonary and cerebral artery Doppler velocimetry in normal and high risk pregnancy

Ginekologia Polska ◽

10.17772/gp/1686 ◽

2014 ◽

Vol 85 (1) ◽

Cited By ~ 2

Author(s):

Andrzej Bręborowicz ◽

Mariusz Dubiel ◽

Marek Pietryga ◽

Grzegorz Bręborowicz ◽

Saemundur Gudmundsson

Keyword(s):

High Risk ◽

Cerebral Artery ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Risk Pregnancy

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Role of Ultrasonography in Screening High Risk Mothers for Detection of IUGR

International Journal of Research and Review ◽

10.52403/ijrr.20211114 ◽

2021 ◽

Vol 8 (11) ◽

pp. 106-112

Author(s):

Gattani Chandrashekhar M ◽

Reddy Pradeep

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Growth Restriction ◽

Adverse Perinatal Outcome ◽

Diastolic Flow ◽

Foetal Monitoring ◽

The Impact

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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Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180184 ◽

2018 ◽

Vol 7 (2) ◽

pp. 628

Author(s):

Rashmi L. ◽

Ashish Bhattacharjee

Keyword(s):

High Risk ◽

Neonatal Intensive Care ◽

Umbilical Artery ◽

Fetal Outcome ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Average Birth Weight ◽

Risk Pregnancy ◽

Umbilical Artery Doppler ◽

Doppler Indices

Background: Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy. The aim of this study was to study the umbilical artery Doppler velocimetry in predicting the fetal outcome in high risk pregnancy. This is a prospective study done over a period of 1 year in Silchar Medical College and Hospital from 1st September 2011 to 31st August 2012. 100 women with singleton pregnancy with high risk admitted in SMCH were subjected to umbilical artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria.Methods: 100 women with high risk pregnancy were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n = 79; 79%), the low-end diastolic flow group (n = 19; 19%) and the group with absent/reversed diastolic flow (n = 2; 2%).Results: Mothers with abnormal velocimetry had more number of caesarean sections than those with normal velocimetry. The diagnosis to delivery interval, gestational age at delivery and average birth weight were comparatively lower with higher incidence of admission to neonatal intensive care unit in foetuses with abnormal umbilical Doppler velocimetry. Sensitivity, specificity, positive and negative predictive values of Doppler for detecting abnormal fetal outcome were 43%, 83%, 33% and 88% respectively. Statistical analysis used: sensitivity, specificity and predictive values.Conclusions: Fetuses with normal flow velocimetry are at lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower than that of neonates with normal velocimetry. Doppler velocimetry studies of umbilical artery can provide the obstetrician important information regarding fetal wellbeing to help him improve fetal outcome.

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Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200367 ◽

2020 ◽

Vol 9 (2) ◽

pp. 729

Author(s):

Hymavathi K. ◽

Prasuna P. ◽

Davuluru Sandhya Rani

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Stress Test ◽

Doppler Velocimetry ◽

Group A ◽

Group B ◽

Group D ◽

Fetal Compromise

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

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Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173475 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3518

Author(s):

Runoo Ghosh ◽

Hina Oza ◽

Shikha Meel

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Lower Limit ◽

Perinatal Outcome ◽

Uterine Artery ◽

Umbilical Artery ◽

Ductus Venosus ◽

Third Trimester ◽

Adverse Perinatal Outcome ◽

Diastolic Velocity

Background: Doppler ultrasound has emerged as beneficial tool in the assessment of the fetal and placental circulation and in the prediction of adverse pregnancy outcome. Umbilical artery Doppler has proved helpful to supervise the growth restricted fetuses and compromised vasculature as in hypertensive disorders high risk pregnancies. Objective of present study was to investigate the association between third-trimester uterine artery Doppler assessment and adverse obstetric outcome.Methods: This prospective study was done among 110 high risk pregnancies. Vessel like uterine artery, umbilical artery, middle cerebral artery and ductus venosus were studied in present study. Indices calculated: Peak systolic velocity, End diastolic velocity, Mean velocity, Systolic/diastolic ratio, Pulsatility index (PI) and resistance index (RI) of middle cerebral artery (MCA), Ductus venosus S/A ratio.Results: bilateral notch was present statistically significant (p<0.05) in 18.1% and absent in 28.2% among cases of adverse perinatal outcome. UA S/D ratio was >3 in 22.7% and <3 in 11.8% among cases of adverse perinatal outcome and findings were statistically significant (p<0.05). End diastolic velocity was reduced in statistically significant (p<0.05) in 9.1% and normal in 20.1% among cases of adverse perinatal outcome. MCA PI was <lower limit statistically significant (p<0.05) in 24.5% and >lower limit in 18.2% among cases of adverse perinatal outcome. MCA PI/UA PI ratio was <1 statistically significant (p<0.05) in 25.5% and absent in 17.3% among cases of adverse perinatal outcome.Conclusions: Increase in UA PI and decrease in MCA PI are early marker for detection of fetal compromise. Ratio of indices between MCA PI and UA PI reflects brain sparing effect as well as placental insufficiency and these are more specific in detection of IUGR than individual artery indices.

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Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Annals of International medical and Dental Research ◽

10.53339/aimdr.2022.8.1.37 ◽

2022 ◽

Vol 8 (1) ◽

pp. 287-295

Author(s):

Manjunath G N

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Resistance Index ◽

Optimal Time ◽

Predictive Values ◽

Placental Perfusion ◽

Adverse Perinatal Outcome ◽

Doppler Study

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

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