Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?

Abstract

In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26-31 weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

“…It is noteworthy that no included study provided data to assess the predictive ability of CPR for adverse neurodevelopmental outcome in pregnancies with suspected FGR. A secondary analysis of the TRUFFLE study 65 reported that CPR was not associated with neurodevelopmental impairment at 2 years' corrected age in fetuses with suspected early-onset growth restriction 66 . Two studies reported similar results for decreased MCA-PI in suspected FGR 67,68 .…”

Severe fetal growth restriction at 26–32 weeks: key messages from the TRUFFLE study

“…There were weak associations between middle cerebral artery (MCA) Doppler and short‐term neonatal outcome, and between MCA Doppler and umbilical:cerebral ratio with 2‐year neurodevelopmental outcome. Although these indices may be informative in understanding the pathophysiological process, they are of no proven benefit in the monitoring or management strategy before 32 weeks' gestation.…”

Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review

“…Thus, it has been reported that qualitative changes in UA Doppler, such as the presence, absence or reversal of end‐diastolic velocity, clearly indicates an increased risk of fetal demise. However, the association between quantitative changes in UA and MCA Doppler, as measured using PI, and perinatal and long‐term outcomes has not been clearly established. Furthermore, the value of Doppler ultrasound in appropriate‐ or large‐for‐gestational‐age fetuses, post‐term pregnancy, pregnancy complicated by diabetes and uncomplicated dichorionic twin pregnancy remains uncertain.…”