Published: 2020-01-28

Cerebro-umbilical doppler ratio as a predictor of adverse perinatal outcome

A. Esther Kamalarani, Sheba Rosette Victor


Background: Intrauterine growth restriction (IUGR) is defined as a subnormal bodyweight or mass in utero. Fetal Doppler studies have been identified as one of the reliable and non-invasive methods of antepartum fetal surveillance in growth-restricted fetuses to detect hypoxemia and to plan timely delivery to precede acidemia. The aim of this study is to evaluate the screening efficacy of the pulsatility indices (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and the ratio of these two indices in predicting the adverse perinatal outcome in pregnancies complicated by IUGR.

Methods: In this study patients were included after diagnosed to have fetal growth restriction clinically by a disparity of four weeks or more between symphysis-fundal height and gestational age and on the serial measurement of symphysis-fundal height after 30 weeks of gestation.

Results: Out of 100 patients who fulfilled the criteria for the study, only 85 patients delivered. Out of them, only 16 women (18.8%) had a ratio of <1.08 which was considered abnormal and the rest of the women (81.2%) had a ratio >1.08 which was considered normal. The specificity for the Cerebro-umbilical ratio (<1.08) to predict adverse perinatal outcome was 96% whereas that for PI of umbilical A (>1.12) was 83% and that for the PI of middle cerebral A (<1.2) was 84%. However, the sensitivities for these indices were very low.

Conclusions: The ratio of the pulsatility indices of the umbilical artery and middle cerebral artery is useful to predict the adverse perinatal outcome.


Fetal doppler- pulsatility index, Intrauterine growth restriction, Perinatal outcome

Full Text:



Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71(2):129-33.

McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Eng J Med. 1999;340(16):1234-8.

Fitzgerald DE, Drumm JE. Non-invasive measurement of the human circulation using ultrasound: a new method. BMJ. 1977;2:1450-1.

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.

Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin Med Insights Pediatr. 2016;10:67-83.

Arias F. Accuracy of the middle-cerebral-toumbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications. Am J Obstet Gynecol. 1994;171:1541-5.

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.

Khanduri S, Chhabra S, Yadav S, Sabharwal T, Chaudhary M, Usmani T, et al. Role of color doppler flowmetry in prediction of intrauterine growth retardation in high-risk pregnancy. Cureus. 2017;9(11):e1827.

Villar J, Carroli G, Wojdyla D, Abalos E, Giordano D, Ba'aqeel H, et al. Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?. Am J Obstet Gynecol. 2006;194(4):921-31.

Teixeira MP, Queiroga TP, Mesquita MD. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital. Einstein (Sao Paulo). 2016;14(3):317-23.