Fetal and Maternal Velocimetry in High Risk Pregnancies for the Assessment of Adverse Perinatal Outcome

Abstract

Pulsed‐Doppler ultrasound assessment of blood flow was performed simultaneously in the fetal middle cerebral artery, umbilical artery, and uteroplacental vessels to verify the incidence of velocimetric abnormalities, as well as their predictive value towards adverse perinatal outcome. Eighteen normal pregnancies and 32 complicated pregnancies (intrauterine growth retardation, pregnancy‐induced hypertension, chronic hypertension and pre‐eclampsia) have been examined between 30th and 40th week of gestation. Waveform abnormalities were detected even in the control group, more frequently in the cerebral artery (11.1%) and umbilical artery (5.5%) than in uteroplacental arteries. Umbilical artery abnormalities were found in intrauterine growth retardation, pregnancy‐induced hypertension, and preeclampsia; while the highest number of anomalous Doppler waveforms in the middle cerebral artery was seen in 71.4% of patients with pregnancy‐induced hypertension. Pathological umbilical artery patterns have shown a diagnostic accuracy of 62% in identifying adverse perinatal outcome. Both middle cerebral artery and uteroplacental vessels demonstrated a diagnostic accuracy of 58%. The false positive rate is 6% for the umbilical artery, 8% for the middle cerebral artery, and 0% for uteroplacental vessels, contrary to current methods of fetal surveillance (such as nonstress test, contraction stress test and biophysical profile), which have a false‐positive rate ranging from 30% to 70%.

Role of modified biophysical profile and cerebroplacental ratio in fetal outcome in low risk and high risk pregnancies

“…5 In a study by Gramalleni et al, CPR was calculated in high risk pregnancies only and they reported that sensivity, specificity, PPV, NPV as 68.0%, 98.4%, 94.4%, and 88% respectively. 6 Number of studies have suggested that the cerebroplacental ratio may be more sensitive in predicting neonatal outcome in pregnancies with placental insufficiency. 7 In a study by Turan S et al, based on 58 pregnant patients, it was observed that instead of using individual methods combining 2 or more antenatal tests yielded much better results in sensitivity while evaluating fetal outcome.…”