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

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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Role of obstetric Doppler in prediction of adverse perinatal outcome in intrauterine growth retardation

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20171055 ◽

2017 ◽

Vol 4 (2) ◽

pp. 529

Author(s):

Chirtrarasan P. ◽

Kanagarameswarakumaran S.

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Meconium Aspiration Syndrome ◽

Ductus Venosus ◽

Optimal Time ◽

Intrauterine Death ◽

Intrauterine Growth ◽

Adverse Perinatal Outcome

Background: Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome. Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation.Methods: 200 singleton pregnancies between 34 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Results: Out of 200 cases, 169 were live born and 24 were neonatal death. There were 5 cases of intrauterine death of foetuses and 2 were still born. Out of the live born 32 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia.Conclusions: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse foetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised foetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised foetuses and helps to determine the optimal time of delivery.

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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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Cerebro-umbilical doppler ratio as a predictor of adverse perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200364 ◽

2020 ◽

Vol 9 (2) ◽

pp. 710

Author(s):

A. Esther Kamalarani ◽

Sheba Rosette Victor

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Intrauterine Growth Restriction ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Growth Restriction ◽

Serial Measurement ◽

Non Invasive ◽

Adverse Perinatal Outcome ◽

Timely Delivery

Background: Intrauterine growth restriction (IUGR) is defined as a subnormal bodyweight or mass in utero. Fetal Doppler studies have been identified as one of the reliable and non-invasive methods of antepartum fetal surveillance in growth-restricted fetuses to detect hypoxemia and to plan timely delivery to precede acidemia. The aim of this study is to evaluate the screening efficacy of the pulsatility indices (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and the ratio of these two indices in predicting the adverse perinatal outcome in pregnancies complicated by IUGR.Methods: In this study patients were included after diagnosed to have fetal growth restriction clinically by a disparity of four weeks or more between symphysis-fundal height and gestational age and on the serial measurement of symphysis-fundal height after 30 weeks of gestation.Results: Out of 100 patients who fulfilled the criteria for the study, only 85 patients delivered. Out of them, only 16 women (18.8%) had a ratio of <1.08 which was considered abnormal and the rest of the women (81.2%) had a ratio >1.08 which was considered normal. The specificity for the Cerebro-umbilical ratio (<1.08) to predict adverse perinatal outcome was 96% whereas that for PI of umbilical A (>1.12) was 83% and that for the PI of middle cerebral A (<1.2) was 84%. However, the sensitivities for these indices were very low.Conclusions: The ratio of the pulsatility indices of the umbilical artery and middle cerebral artery is useful to predict the adverse perinatal outcome.

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

MedPulse International Journal of Gynecology ◽

10.26611/10121028 ◽

2019 ◽

Vol 12 (2) ◽

pp. 53-58

Author(s):

Sanjaya Sharma ◽

◽

Shushila Kharakwa ◽

Shruti Gupta ◽

Prakhar Mohniya ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Umbilical Artery ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Adverse Perinatal Outcome ◽

Risk Pregnancy

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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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Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20160287 ◽

2016 ◽

pp. 403-414

Author(s):

Rajesh Kuber ◽

Shubreet Randhawa ◽

Sanjay Khaladkar ◽

Abhijit Patil

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Umbilical Artery ◽

Doppler Study ◽

Uterine Growth

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P07.13: Intrauterine growth restriction: correlation between perinatal outcome and Doppler study of middle cerebral artery

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.7109 ◽

2009 ◽

Vol 34 (S1) ◽

pp. 205-206

Author(s):

L. Almeida Toledano ◽

L. Pallarès Porta ◽

L. Lopez ◽

L. Alué Ponti ◽

J. Sabrià ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Intrauterine Growth Restriction ◽

Perinatal Outcome ◽

Growth Restriction ◽

Intrauterine Growth ◽

Doppler Study

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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.

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