Doppler findings of fetal circulation associated with types of birth and parturients grouped according to Robson’s classification
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260155Keywords:
Cesarean section, Delivery, Doppler, Fetus, Parturients, Robson classificationAbstract
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
References
Turner JM, Mitchell MD, Kumar SS. The physiology of intrapartum fetal compromise at term. Am J Obstet Gynecol. 2020;222(1):17-26. DOI: https://doi.org/10.1016/j.ajog.2019.07.032
Kane AD, Kothmann E, D A Giussani DA. Detection and response to acute systemic hypoxia. BJA Educ. 2020;20(2):58-64. DOI: https://doi.org/10.1016/j.bjae.2019.10.004
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. DOI: https://doi.org/10.1177/8756479314563541
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. DOI: https://doi.org/10.1016/j.ajog.2014.10.024
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. DOI: https://doi.org/10.1080/14767058.2022.2152670
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. DOI: https://doi.org/10.1016/j.siny.2024.101543
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. DOI: https://doi.org/10.1002/uog.5386
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. DOI: https://doi.org/10.1590/0100-3984.2022.0104
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. DOI: https://doi.org/10.1136/bmjopen-2021-049799
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. DOI: https://doi.org/10.3109/14767058.2013.804049
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. DOI: https://doi.org/10.1002/uog.5377
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. DOI: https://doi.org/10.1159/000441519
ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics. Ultrasound Obstet Gynecol 2021;58:331-9. DOI: https://doi.org/10.1002/uog.23698
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. DOI: https://doi.org/10.1002/uog.19073
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. DOI: https://doi.org/10.1002/uog.20102
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. DOI: https://doi.org/10.1002/uog.14824
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. DOI: https://doi.org/10.1002/uog.20157
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. DOI: https://doi.org/10.3349/ymj.2004.45.2.273
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. DOI: https://doi.org/10.18203/2320-1770.ijrcog20231941
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. DOI: https://doi.org/10.1002/hsr2.1274
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. DOI: https://doi.org/10.3109/14767058.2013.814634
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. DOI: https://doi.org/10.1055/a-0659-6873
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. DOI: https://doi.org/10.1016/j.ajog.2015.05.024
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. DOI: https://doi.org/10.7196/sajog.1590
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. DOI: https://doi.org/10.1016/j.mefs.2013.04.008
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. DOI: https://doi.org/10.21608/egyfs.2023.320842
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.
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. DOI: https://doi.org/10.1080/14767058.2017.1355900
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. DOI: https://doi.org/10.1155/ogi/7881711