Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study

Abstract

Objective To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term. Material and Methods Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10th and 90th percentile, at 36 + 0–37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data. Results 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor. Conclusion Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

Adverse intrapartum outcome in pregnancies complicated by small for gestational age and late fetal growth restriction undergoing induction of labor with Dinoprostone, Misoprostol or mechanical methods: A systematic review and meta-analysis

“…SGA fetuses with normal umbilical and cerebral Doppler are commonly considered to be at lower risk of adverse perinatal outcome compared to late FGR and have perinatal outcomes similar to appropriately grown fetuses. [37][38][39] Although a significant proportion of these fetuses are constitutionally small, but healthy, they may still be at a higher risk of some adverse events, mainly CS for NRFS. [40][41][42] In the present systematic review, the impact of mechanical methods of IOL when applied to "simple" SGA fetuses, was more difficult to ascertain in view of the small number of included cases, with the large majority of outcomes in the Misoprostol group reported only by a single study.…”

Combination of Doppler measurements with amniotic fluid volume for the prediction of perinatal outcomes in fetal growth restriction

“…The assessment of placental insufficiency and FGR is based on Doppler ultrasound evaluation by combining maternal (uterine artery [UtA]) and fetal (middle cerebral artery [MCA] and umbilical artery [UA]) Doppler indices. Doppler ultrasound evaluation is the most common and precise method for the assessment of fetal and placental circulation and the prediction of fetal well‐being and pregnancy outcomes 5 . Throughout the years, many Doppler parameters have been used for fetal well‐being evaluation 6 .…”

“…Doppler ultrasound evaluation is the most common and precise method for the assessment of fetal and placental circulation and the prediction of fetal well-being and pregnancy outcomes. 5 Throughout the years, many Doppler parameters have been used for fetal well-being evaluation. 6 Many previous studies have stated that increased resistance in the UtA is related to high fetal distress risk in labor and high neonatal intensive care unit (NICU) admission rates.…”

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

“…Studies investigating the ratio of MCA pulsatility index (PI) to UA PI – referred to as the cerebroplacental ratio (CPR) – have shown heterogeneous results regarding the prediction of adverse perinatal outcome 7 10 11 . Interestingly, the reversal of this ratio – termed the umbilical-to-cerebral ratio (UCR) – seems to be a more potent discriminator in estimating progressive fetal hypoxia 12 13 .…”

“…Especially, from 37 weeks of gestation onwards FGR fetuses are at increased risk of being undetected prenatally with the consecutive risk of adverse perinatal outcome [4]. Although sonography is part of the daily obstetrical routine, screening for compromised fetuses at term still remains a major challenge within various collectives of fetuses [5][6][7][8][9].…”