Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler

Hershkovitz, Reli; Kingdom, John; Geary, Michael; Rodeck, C. H.

doi:10.1046/j.1469-0705.2000.00079.x

Cited by 240 publications

(182 citation statements)

References 23 publications

(21 reference statements)

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“…In FGR, as the umbilical artery Pi is increased, and the MCA PI may be reduced, the CPR is low. 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].…”

Section: Fetal Dopplermentioning

confidence: 99%

“…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].…”

Section: Fetal Dopplermentioning

confidence: 99%

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

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth. HIGHLIGHTS Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, the majority of fetuses suffering from stillbirth at term are not small for gestational age. Serial measurements to assess growth velocity, combined with fetal Doppler, are preferable than a single point estimate. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term  The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth Highlights (for review) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 ABSTRACT Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the t...

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Section: Fetal Dopplermentioning

confidence: 99%

Section: Fetal Dopplermentioning

confidence: 99%

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

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Furthermore, this sequential deterioration can rarely be observed beyond 32-34 weeks of gestation. After this period, the fetal growth asymmetry and the brain sparing effect can be the only evidence of placental insufficiency and fetal hypoxia (32)(33)(34), which implies that the hemodynamic indicators of fetal distress should be searched for in the fetal cerebral circulation.…”

Section: Introductionmentioning

confidence: 99%

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

Salihagič-Kadić

Medić

Jugović

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

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However, our latest study on growth restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using a new vascular score, the hypoxia index. This parameter, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily % C / U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.

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“…MCA may be valuable for the identification of adverse outcome among late-onset FGR though its role in prediction is weak, independently of umbilical artery Doppler, which is often normal in these fetuses [69][70][71]. The cerebroplacental ratio (CPR) quantifies the redistribution of cardiac output by dividing the Doppler indices of the middle cerebral artery (MCA) with that of the umbilical artery.…”

Section: Middle Cerebral Artery Dopplermentioning

confidence: 99%

Early onset fetal growth restriction

Nawathe

Lees

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.

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Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler

Abstract: MCA Doppler may be a useful tool to assess the health of small fetuses in the late third trimester. Redistribution may occur in the presence of normal umbilical artery Doppler and should be suspected when the HC/AC ratio is elevated.

Cited by 240 publications

References 23 publications

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

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

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

Early onset fetal growth restriction

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