Cerebral-Umbilical Doppler Ratio As a Predictor of Adverse Perinatal Outcome

Abstract

Using a 3.5-MHz duplex Doppler system, 45 normal-growth and 45 growth-retarded fetuses were studied between 30-41 weeks' gestation. Velocity recordings were obtained from the middle cerebral artery and umbilical artery to calculate the ratio between the two pulsatility indexes. The cerebral-umbilical Doppler ratio is usually constant during the last 10 weeks of gestation. Therefore, a single cutoff value (1.08) was used, above which velocimetry was considered normal and below which it was considered abnormal. The cerebral-umbilical Doppler ratio provided a better predictor of small for gestational age newborns and adverse perinatal outcome than either the middle cerebral artery or umbilical artery alone. In fact, in predicting those newborns who were small for gestational age, the cerebral-umbilical ratio had a 70% diagnostic accuracy [(true positive + true negative)/total number of cases], compared with 54.4% for the middle cerebral artery and 65.5% for the umbilical artery. The results were more encouraging for prediction of adverse perinatal outcome; diagnostic accuracy for the cerebral-umbilical ratio was 90%, compared with 78.8% for the middle cerebral artery and 83.3% for the umbilical artery.

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

“…Cerebroumbilical PI ratio was proposed by Gramellini et al and he suggeted that MCA/umbilical PI ratio had higher diagnostic accuracy and sensitivity in detecting IUGR (70%) and adverse perinatal outcome (90%) as compared to individual PI of umbilical and middle cerebral artery. 4 Similar to our findings, Ozeren et al also found that though cerebroumbilical PI ratio was higher in patients with preeclampsia, but had a lower sensitivity and diagnostic accuracy to predict adverse perinatal outcome. 11 Lakhar et al also found that umbilical artery PI is more sensitive than cerebroumbilical PI ratio in predicting adverse perinatal outcome.…”

“…In this study C/U PI ratio < 1.08 was taken as abnormal and predicted adverse perinatal outcome with 90% accuracy as compared to MCA PI or UA PI alone. 4 Bano S et al also in a recent study stressed that C/U PI ratio is a better predictor for adverse perinatal outcome. Apart from MCA-PI, MCA-PSV (peak systolic velocity) also holds promise.…”

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

“…Fetal brain sparing (low MCA PI or CPR) has been associated with adverse pregnancy outcomes, even in fetuses with normal umbilical artery Doppler [45,49]. However, the CPR improves the prediction of adverse pregnancy outcomes when compared to its individual components [49][50][51][52][53]. It has been shown that a suboptimal or low CPR is associated with short-term markers of neonatal outcome such as cord blood acidemia, need for emergency operative delivery and neonatal unit admission [54][55][56][57], as well as stillbirth and neonatal morbidity [48,[57][58][59].…”

Fetal cerebrovascular response to chronic hypoxia—implications for the prevention of brain damage

“…Many studies (19,(21)(22)(23)(24) have confirmed that this parameter has a high sensitivity and specificity in detection of fetal blood flow redistribution and prediction of fetal hypoxia in growth-restricted human fetuses. It has been shown that the sensitivity of the C/U ratio in the prediction of perinatal outcome exceeds the sensitivity of cerebral resistance or UA RI alone, even in pregnancies complicated by only moderate hypoxia (21,22).…”