Correlation of efficacy of cerebro placental ratio with adverse perinatal outcome in clinically suspected IUGR pregnancies
Keywords:Cerebro plecental ratio, Color doppler, IUGR, Pulsatility index
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.
Gardosi J. Clinical strategies for improving the detection of fetal growth restrictions. Clin Perinatol. 2011;38:21-31.
Shand AW, Buckle JH, Nathan E, Dickinson JE, French NP. Small for gestational age, preterm infants and relationship of abnormal artery Doppler blood flow to perinatal mortality and neuro development outcome. Aust N Z J Obstet Gynecol. 2009;49(1).
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;36:86-98.
Bekedam DJ, Visser GH, Vander Zee AG, Snijders RJ, Poelmann-Weesjes G. Abnormal velocity waveforms of umbilical artery in growth-retarded fetuses; relationship to antepartum late hr decelerations and outcome. Early Hum Dec. 1990;24:79-89.
Campbell S, Vyas S, Nicolaides KH. Doppler investigation of fetal circulation. J Perinat Med. 1991;19:21-6.
Mari G, Uerpairjkit B, Abuhamad AZ, Copel JA. Adrenal artery velocity waveforms in appropriate and small for gestation fetuses. Ultrasound Obstet. Gynecol. 1996;8:82-6.
Abuhamad AZ, Mari G, Bogdan D, Evansep. Doppler flow velocimetry of the splenic artery in human fetus; is it a matter of chronic hypoxia? Am J Obstet Gynaecol, 172, 1995, 820-825.
Hecherk, Campbell S, Doyle P, Herrington K, Nicolaides KM. Assessment of fetal compromised by Doppler ultrasound investigation of the fetal circulation: Arterial, intracranial and venus blood flow velocity studies. Circ. 1995;91:129-38.
Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical flow velocity waveform and placental resistance pathological correlation. Br J Obstet Gynaecol 1985;92:31-8.
Battaalia FC, Lubchenko LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71:159-62.
Piazze J, Padula F, Cerekja A, Cosmi EV, Anceschi MM. Prognostic value of umbilical-middle cerebral artery pulsatility index ratio in fetuses with growth restriction. Int J Gynaecol Obstet. 2005;91(3):233-7.
Erlan AK, He JP, Tanriverdi HA, Hendrick J, Linvach HG, Schmidt W. Comparison of perinatal outcome in fetuses with reverse or absent diastolic flow in the umbilical artery and/or fetal descending aorta. J Perinat Med. 2003;31(4):307-12.
Gerber S, Hohlfeld P, Viquerat F, Tolsa JF, Vial Y. Intrauterine growth restriction and absent or reverse end-diastolic blood flow in umbilical artery (Doppler class II or III): A retrospective study of short- and long-term fetal morbidity and mortality. Eur J Obstet Gynecol Reprod Biol. 2006;126(1):20-6.
Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical velocimetry. Obstet Gynecol. 1997;90(6):953-7.
Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. IJRI. 2006;16(1):109-16.
Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral umbilical Doppler ratio as a predictor of adverse perinatal outcome. Cerebral and umbilical ratio. Obstet Gynecol. 1992;79:416-20.
Bano S, Chaudhary V, Pande S, Mehta VL, Sharma AK. Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. Indian J Radiol Imaging 2010;20:20-5.
Fong KW, Ohlsson A, Hannah ME, Grisaru S, Kingdom J, Cohen H, et al. Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiol. 1999;213(3):681-9.
Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, et al. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol. 1999;180:750-6.