Correlation of longitudinal changes that occur in fetal middle cerebral artery-peak systolic velocity with middle cerebral artery-pulsatility index in late onset intrauterine growth restriction cases

Manisha Sharma, Priyanka Chaudhary, Jasmine Chawla Sharma, Mohit Chaudhary, Piyush Jain


Background: Fetal blood flow can be studied by Doppler patterns which follow a longitudinal trend with sequential changes in umbilical artery, middle cerebral artery followed by other peripheral arteries. Though FGR cannot be treated but morbidity and mortality can be decreased by studying longitudinal changes in MCA-PI (middle cerebral artery-pulsatility index) and MCA-PSV (middle cerebral arterial-peak systolic velocity) and terminating the pregnancy at appropriate time.

Methods: A prospective observational study was conducted from 2018 to 2019 on 29 antenatal patients with suspicion of fetal growth restriction at ≥32 weeks gestation. Patients with late onset FGR by Delphi procedure with singleton pregnancy and confirmed gestational age were included. Patients with gross congenital anomaly or multiple pregnancy were excluded. Peak systolic velocity, resistance index and PI in middle cerebral artery were recorded in absence of fetal movements. MCA-PSV >95th percentile and MCA-PI <5th percentile for that gestational age were considered abnormal. The compiled data was subjected to statistical analysis.

Results: Mean gestational age was 36.28±1.6 weeks at enrolment and 36.65±1.56 weeks at delivery. The longitudinal changes in MCA-PSV values showed an increase in all the patients but in 11 patients, it was abnormal and out of these there was fall in 6 patients after an increase. MCA-PSV fall was strongly associated with perinatal mortality (p value 0.0003 and kappa 0.664). In 22 patients with increase in MCA-PSV there was decrease in MCA-PI while in 7 patients MCA PI increased which could be due to pseudo normalization phenomenon due to cerebral oedema. Association of MCA-PSV fall with adverse perinatal outcome was not significant (p value >0.05). The sensitivity of MCA-PSV fall in predicting the perinatal mortality was 80% and specificity was 91.76%.

Conclusions: MCA-PSV not only complements MCA-PI but also provides more accurate information than does MCA-PI alone and should be used along with MCA-PI for optimizing fetomaternal outcome.


MCA-PSV fall, MCA-PI, Late onset IUGR, Perinatal outcome

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