Doppler findings of fetal circulation associated with types of birth and parturients grouped according to Robson’s classification

Metodi E. Trajchevski

doi:10.18203/2320-1770.ijrcog20260155

Authors

Metodi E. Trajchevski Department of High- Risk Pregnancy, Specialized Hospital for Gynecology and Obstetrics-Mother Tereza Cair, Skopje, North Macedonia

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260155

Keywords:

Cesarean section, Delivery, Doppler, Fetus, Parturients, Robson classification

Abstract

Background: Through the detection of the circulatory conditions in the fetus, an insight into the subsequent events during the course and outcome of the pregnancy and birth is possible. The aim of the study was to gain an insight into the Doppler findings from the prenatal investigations and their association with the types of delivery and the ratio between women in from the Robson classification in relation to the studied variables.

Methods: 329 pregnant women at prenatal ultrasound examinations were studied with Doppler assessment of fetal mca(PI) (middle cerebral artery) (pulsatility index), aUPI (umbilical artery) and aUtPI (uterine artery) and followed until delivery when they were grouped according to the Robson classification. Values from Doppler findings as well as data from the current pregnancy and the obstetric history of the included pregnancies were analyzed with statistical tests.

Results: A statistically significant association was established between higher values of mcaPI in fetuses delivered by elective cesarean section and lower values in fetuses delivered vaginally, by emergency cesarean section and elective cesarean section after unsuccessful induction of labor. A significant difference was also shown by the comparison between Robson’s classes.

Conclusions: The Doppler indices of the examined arteries indicating proper fetal circulation were associated with vaginal delivery. Together with the currently confirmed prerequisites for successful induction of labor and vaginal delivery, the findings of fetal circulation studies can serve as an additional parameter for predicting the type of delivery and managing the labor.

Metrics

Metrics Loading ...

References

Turner JM, Mitchell MD, Kumar SS. The physiology of intrapartum fetal compromise at term. Am J Obstet Gynecol. 2020;222(1):17-26.

Kane AD, Kothmann E, D A Giussani DA. Detection and response to acute systemic hypoxia. BJA Educ. 2020;20(2):58-64.

Mulrooney JS. Uterine artery Doppler of the gravid uterus as a predictor identifying at-risk pregnancies: a meta-analysis. J Diagn Med Sonograph. 2015;31(1):64-9.

Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol. 2015;213(1):54-e1.

Mathewlynn S, Beriwal S, Ioannou C, Cavallaro A, Impey L. Abnormal umbilical artery pulsatility index in appropriately grown fetuses in the early third trimester: an observational cohort study. J Matern Fet Neonat Med. 2023;36(1):2152670.

Eslamian L, Samaei Nouroozi A, Jamal A, Farahbod F. The role of intrapartum doppler of uterine and middle cerebral artery evaluation on prediction and prevention of adverse perinatal outcome in normal size fetuses at term. Radiol Diagn Imag. 2020;4:1-7.

Lear CA, Dhillon SK, Nakao M, Lear BA, Georgieva A, Ugwumadu A, et al. The peripheral chemoreflex and fetal defenses against intrapartum hypoxic-ischemic brain injury at term gestation. Semin Fet Neonat Med. 2024;29(4-5):101543.

Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch D, et al. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;32(2):160-7.

Fracalozzi JD, Okido MM, Crott GC, Duarte G, Cavalli RD, Araujo Júnior E, et al. Maternal, obstetric, and fetal Doppler characteristics in a high-risk population: prediction of adverse perinatal outcomes and of cesarean section due to intrapartum fetal compromise. Radiol Brasil. 2023;56:179-86.

Ali S, Heuving S, Kawooya MG, Byamugisha J, Grobbee DE, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review. BMJ Open. 2021;11(12):e049799.

Morales Roselló J, Hervás Marín D, Perales Marín A. Can we predict delivery date with obstetric ultrasound? J Matern Fet Neonat Med. 2013;26(18):1807-11.

Hernandez‐Andrade E, Figueroa‐Diesel H, Jansson T, Rangel‐Nava H, Gratacos E. Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth‐restricted fetuses. Ultrasound Obstet Gynecol. 2008;32(1):71-6.

Morales-Roselló J, Khalil A, Salvi S, Townsend R, Premakumar Y, Perales-Marín A. Abnormal middle cerebral artery Doppler associates with spontaneous preterm birth in normally grown fetuses. Fet Diagnos Ther. 2016;40(1):41-7.

ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics. Ultrasound Obstet Gynecol 2021;58:331-9.

Nicolaides KH, Wright D, Syngelaki A, Wright A, Akolekar R. Fetal medicine foundation fetal and neonatal population weight charts. Ultrasound Obstet Gynecol. 2018;52(1):44-51.

Oros D, Ruiz-Martinez S, Staines-Urias E, Conde-Agudelo A, Villar J, Fabre E, et al. Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review. Ultrasound Obstet Gynecol. 2019;53(4):454-64.

Akolekar R, Sarno L, Wright A, Wright D, Nicolaides KH. Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol. 2015;45(4):402-8.

Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019;53(4):465-72.

Roje D, Ivo B, Ivica T, Mirjana V, Vesna C, Aljosa B, et al. Gestational age-the most important factor of neonatal ponderal index. Yonsei Med J. 2004;45(2):273-80.

Robson Classification: Implementation Manual. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Patil SB, Rajitha D. Robson classification: beyond caesarean rates. Int J Reprod Contracept Obstet Gynecol. 2023;12(7):2241-6.

Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: a call to action. Health Sci Rep. 2023 May;6(5):e1274.

Morales-Roselló J, Hervás-Marín D, Perales-Marín A. Proximity of term labor deepens the fall of Doppler impedance in the fetal cerebral arteries. J Matern Fet Neonat Med. 2014;27(3):283-90.

Widschwendter P, Lato K, Friedl TW, Janni W, Friebe-Hoffmann U. Foetal Doppler parameters as a prognostic marker before induction of labour. Geburtshilf Frauenheilkund. 2018;78(09):859-65.

Greggory R DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015;213(1):5-15.

Wise AJ, Nicolaou E, Lombaard H. The use of the cerebroplacental ratio in the latent phase of labour to predict adverse outcomes in a resource-limited (SA). S Afr J Obstet Gynecol. 2020;26(2):48-53.

Abdella RM, Ahmed SA, Moustafa MI. Sonographic evaluation of fetal abdominal circumference and cerebroplacental Doppler indices for the prediction of fetal macrosomia in full term pregnant women. Cohort study. Middle East Fertil Soc J. 2014;19(1):69-74.

Belal D, Al Mohammady M, Mohamed S, Mahmoud M. Fetal middle cerebral artery Doppler in post term pregnancy: a predicting factor for induction of labor outcome. Egypt J Fertil Steril. 2023;27(5):14-22.

Vannuccini S, Torricelli M, Bocchi C, Severi FM, Di Tommaso M, Petraglia F. Fetal middle cerebral artery Doppler in late-term pregnancy: a predicting factor for failed induction of labor. J Matern Fet Neonat Med. 2018;31(20):2756-62.

Gautam V, Gaikwad HS, Nath B, Shukla M, Kumari P. Prediction model for successful induction of labor by fetal middle cerebral artery pulsatility index and obstetric factors in term pregnancy: a prospective cohort study. Obstet Gynecol Int. 2025;7881711:9.