Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses

Monteith, Cathy; Flood, Karen; Müllers, Sieglinde; Unterscheider, Julia; Breathnach, Fionnuala; Daly, Seán; Geary, Michael; Kennelly, Máiréad; McAuliffe, Fionnuala M.; O’Donoghue, Keelin; Hunter, A.R.; Morrison, John J.; Burke, Gerald; Dicker, Patrick; Tully, Elizabeth; Malone, Fergal D.

doi:10.1016/j.ajog.2016.11.1008

Cited by 27 publications

(22 citation statements)

References 29 publications

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“…Ibrahim et al also revealed a lower PI value of MCA as a highly specific value for predicting FGR and fetal demise [24]. Monteith et al have shown the importance of a serial abnormal CPR <1 as a potential predictor of adverse outcomes among 1116 SGA fetuses [25].…”

Section: Sharbaf Et Almentioning

confidence: 99%

Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction

et al. 2018

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Background: Although using Doppler ultrasonography of umbilical structures is a common method for predicting prenatal adverse outcome, recent studies have proposed the importance of middle cerebral artery (MCA) Doppler assessment for antenatal monitoring. The aim of the present study was to compare alterations in the fetalMCAversus umbilical artery (UA) pulsatility indices (PI) in complicated pregnancies by fetal growth restriction (FGR). Methods: A cohort study was carried out in Yas Hospital (Tehran, Iran) in 2016. One hundred fifty pregnant women in third trimester with estimation of FGR participated in the study. Transabdominal ultrasound was performed to determine fetal weight. After birth, all neonates were divided into 2 groups: small for gestational age (SGA) and non-SGA.We compared the values of UA and MCA Doppler in predicting SGA. Data were analyzed with t-test and Chi-square test. Results: After delivery, 126 mothers had SGA while 24 subjects had non-SGA neonates. Unlike UA PI, MCA artery PI of the SGA and non-SGA groups were significantly different (p=0.062 for UA PI comparison; p=0.0001 for MCA PI comparison). Of the 126 cases, there was decreased MCA PI in 40.5% of fetuses and increased UA PI in 22.2% of fetuses. There were significant differences in both sensitivity and specificity for MCA PI versus UA PI (p=0.014 for sensitivity; p=0.009 for specificity). Conclusion: Results showed that of all the SGA cases, a decrease in MCA PI was more notable than changes in UA PI. Sensitivity, specificity and prediction of SGA for MCA PI were higher than those for UA PI.

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Section: Sharbaf Et Almentioning

confidence: 99%

Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction

et al. 2018

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“…; Monteith et al . ). Considerable epidemiological evidence in humans and experimental evidence from animal models of IUGR demonstrate that fetal undernutrition, usually associated with placental insufficiency, produces developmental adaptations that predispose offspring to metabolic disorders of insulin secretion and glucose utilization (insulin sensitivity) at later stages of life (Barker et al .…”

Section: Introductionmentioning

confidence: 97%

“…Although this statistical classification introduces heterogeneity by including newborns who are genetically predetermined to be small along with cases of IUGR where pathological fetal vascular patterns can be identified with Doppler assessments of the middle cerebral and umbilical artery, aorta and the ductus venosus, these studies provide important observations on insulin secretion and sensitivity which have been confirmed experimentally in animal models of placental insufficiency (Platz & Newman, ; Monteith et al . ). Such observations include those made by umbilical cord blood sampling in human SGA fetuses prior to delivery or the onset of labour.…”

Section: Introductionmentioning

confidence: 97%

Fetal adaptations in insulin secretion result from high catecholamines during placental insufficiency

Limesand

Rozance

2017

The Journal of Physiology

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Placental insufficiency and intrauterine growth restriction (IUGR) of the fetus affects approximately 8% of all pregnancies and is associated with short- and long-term disturbances in metabolism. In pregnant sheep, experimental models with a small, defective placenta that restricts delivery of nutrients and oxygen to the fetus result in IUGR. Low blood oxygen concentrations increase fetal plasma catecholamine concentrations, which lower fetal insulin concentrations. All of these observations in sheep models with placental insufficiency are consistent with cases of human IUGR. We propose that sustained high catecholamine concentrations observed in the IUGR fetus produce developmental adaptations in pancreatic β-cells that impair fetal insulin secretion. Experimental evidence supporting this hypothesis shows that chronic elevation in circulating catecholamines in IUGR fetuses persistently inhibits insulin concentrations and secretion. Elevated catecholamines also allow for maintenance of a normal fetal basal metabolic rate despite low fetal insulin and glucose concentrations while suppressing fetal growth. Importantly, a compensatory augmentation in insulin secretion occurs following inhibition or cessation of catecholamine signalling in IUGR fetuses. This finding has been replicated in normally grown sheep fetuses following a 7-day noradrenaline (norepinephrine) infusion. Together, these programmed effects will potentially create an imbalance between insulin secretion and insulin-stimulated glucose utilization in the neonate which probably explains the transient hyperinsulinism and hypoglycaemia in some IUGR infants.

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“…When comparing different thresholds, Bligh et al showed CPR less than the 10th centile had the best overall test performance in low-risk pregnancies at term. 15 CPR in restricted vs. appropriate growth Most studies analysing the predictive value of CPR have been performed in early and late IUGR cohorts and show CPR to be a significant predictor of, for example, operative delivery for fetal distress. 11,12 Timing the measurement In deciding when to measure the CPR, the suggestion was made that its predictive value decreases over time.…”

Section: Data Interpretationmentioning

confidence: 99%

“…14 Secondary analysis of the PORTO study also showed that an abnormal CPR value was best interpreted at less than 34 weeks gestation. 15 CPR in restricted vs. appropriate growth Most studies analysing the predictive value of CPR have been performed in early and late IUGR cohorts and show CPR to be a significant predictor of, for example, operative delivery for fetal distress. 11,13,[16][17][18] When evaluating CPR in appropriately grown fetuses, recent reports used data from healthy post-term pregnancies.…”

Section: Data Interpretationmentioning

confidence: 99%

Cerebro‐placental ratio – Is it time to start putting it to use?

Moreta

Benzie

2017

Australas J Ultrason Med

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Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses

Cited by 27 publications

References 29 publications

Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction

Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction

Fetal adaptations in insulin secretion result from high catecholamines during placental insufficiency

Cerebro‐placental ratio – Is it time to start putting it to use?

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