Predictive performance of fetal aortic isthmus Doppler velocimetry and the cerebro-placental ratio in cases with fetal growth restriction
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243574Keywords:
Cerebroplacental ratio, Aortic isthmus doppler, Fetal growth restrictionAbstract
Background: Fetal growth restriction (FGR) is one of the leading causes of intrauterine fetal demise, cerebral palsy and perinatal death. The main cause of FGR is placental insufficiency. Cerebroplacental ratio (CPR) is decreased with the progression of FGR. Fetal aortic isthmus (AoI) Doppler has been suggested as a useful prognostic marker in monitoring of FGR fetuses. Objective of the study is to evaluate the relation between the AoI Doppler and CPR on the perinatal outcome in cases with FGR.
Methods: This is a prospective observational cohort study that entailed 100 cases from November 2022 to October 2023. Group A: 50 cases are normal control and group B: 50 cases are FGR. Doppler interrogation of umbilical artery (UA), and middle cerebral artery (MCA), and AoI had been underwent in all cases at GA window: 28-37 weeks within 48 hours before delivery. All cases were assessed after delivery for Apgar score at 10 minutes and admission to the neonatal intensive care unit (NICU).
Results: NICU admission was statistically significantly higher in cases and controls with higher AoI pulsatility index (PI) values and lower CPR values. The sensitivity of CPR for prediction of NICU admission was higher than the sensitivity of AoI-PI to predict it (41.94% versus 22.58%).
Conclusions: Abnormal fetal AoI Doppler velocimetry is correlated with abnormal CPR in FGR fetuses. Abnormalities in the PI of AoI-PI and CPR in FGR fetuses had association with adverse perinatal outcome. Further studies needed to test the predictive performance of AoI-PI for adverse perinatal outcomes before its enrollment in the daily practice of FGR cases management.
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References
Fetal growth restriction. ACOG Practice Bulletin No. 227. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e16-28.
MacDonald TM, McCarthy EA, Walker SP. Shining light in dark corners: diagnosis and management of late-onset fetal growth restriction. Aust N Z J Obstet Gynaecol. 2015;55(01):3-10.
Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(02):86-98.
Ferraz MM, Araujo FDV, Carvalho PRN, Sa RAM. Aortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review. Rev Bras Ginecol Obstet. 2020;42(5):289-96.
Benavides-Serralde A, Scheier M, Cruz-Martinez R, Crispi F, Figueras F, Gratacos E, et al. Changes in central and peripheral circulation in intrauterine growth-restricted fetuses at different stages of umbilical artery flow deterioration: new fetal cardiac and brain parameters. Gynecol Obstet Invest. 2011;71(04):274-80.
Brantberg A, Sonesson SE. Central arterial hemodynamics in small-for-gestational-age fetuses before and during maternal hyperoxygenation: a Doppler velocimetric study with particular attention to the aortic isthmus. Ultrasound Obstet Gynecol. 1999;14(04):237-43.
Kennelly MM, Farah N, Turner MJ, Stuart B. Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction. Prenat Diagn. 2010;30(05):395-401.
Makikallio K, Jouppila P, Rasanen J. Retrograde net blood flow in the aortic isthmus in relation to human fetal arterial and venous circulations. Ultrasound Obstet Gynecol. 2002;19(02):147-52.
Del RioM, Martinez JM, Figueras F, BennasarM, Olivella A, Palacio M, et al. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;31(01):41-7.
Figueras F, Benavides A, Del Rio M, Crispi F, Eixarch E, Martinez JM, et al. Monitoring of fetuses with intrauterine growth restriction: longitudinal changes in ductus venosus and aortic isthmus flow. Ultrasound Obstet Gynecol. 2009;33(01):39-43.
Fouron JC, Gosselin J, Amiel-Tison C, Infante-Rivard C, Fouron C, Skoll A, Veilleux A. Correlation between prenatal velocity waveforms in the aortic isthmus and neurodevelopmental outcome between the ages of 2 and 4 years. Am J Obstet Gynecol. 2001;184 (04):630-6.
Kennelly MM, Farah N, Hogan J, Reilly A, Turner MJ, Stuart B. Longitudinal study of aortic isthmus Doppler in appropriately grown and small-for-gestational-age fetuses with normal and abnormal umbilical artery Doppler. Ultrasound Obstet Gynecol. 2012;39(04):414-20.
Vasudeva A, Padavagodu Shivananda R, Shashidar DSB, Mundkur A, Samanth J, Hegde N, et al. Clinical utility of aortic isthmus Doppler in the prediction of perinatal outcomes. AJOG Glob Rep. 2022;2(4):100102.
Del RíoM, Martínez JM, Figueras F, BennasarM, Palacio M, Gómez O, et al. Doppler assessment of fetal aortic isthmus blood flow in two different sonographic planes during the second half of gestation. Ultrasound Obstet Gynecol. 2005;26(02):170-4.
Gámez F, Rodríguez MJ, Tenías JM, García J, Pintado P, Martín R, et al. Reference ranges for the pulsatility index of the fetal aortic isthmus in singleton and twin pregnancies. J Ultrasound Med. 2015;34(4):577-84.
Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Use of the 3-vessel view to record Doppler velocity waveforms from the aortic isthmus in normally grown and growth-restricted fetuses: comparison with the long aortic arch view. J Ultrasound Med. 2008;27(11):1617-22.
Sonesson SE, Fouron JC. Doppler velocimetry of the aortic isthmus in human fetuses with abnormal velocity waveforms in the umbilical artery. Ultrasound Obstet Gynecol. 1997;10(02):107-11.
Karakus R, Ozgu-Erdinc AS, Esercan A, Dogan MM. Doppler assessment of the aortic isthmus in intrauterine growth-restricted fetuses. Ultrasound Q. 2015;31(03):170-4.
Choudhary P, Malik A, Batra A. Cerebroplacental ratio and aortic isthmus Doppler in early fetal growth restriction. J Clin Ultrasound. 2021;49(7):754-61.
Sharma KA, Swami S, Dadhwal V, Perumal V, Deka D. Aortic isthmus Doppler in normal and small-for-gestational-age fetuses and its association with prediction of adverse perinatal outcome. Int J Gynaecol Obstet. 2021;153(3):542-8.
Younesi L, Ghadamzadeh M, Amjad G, Lima ZS. Color Doppler sonography of the aortic isthmus in intrauterine growth-restricted fetuses and normal fetuses. Eur J Transl Myol. 2018;28(4):7773.
Turan S, Turan OM, Berg C, Moyano D, Bhide A, Bower S, et al. Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses. Ultrasound Obstet Gynecol 2007;30:750-6.
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol. 1985;151:333-7.
