Middle cerebral arterial flow redistribution is an indicator for intrauterine fetal compromise in late pregnancy in low‐resource settings: A prospective cohort study

Abstract

We aimed to determine the prevalence of abnormal umbilical artery (UA), uterine artery (UtA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR) Doppler, and their relationship with adverse perinatal outcomes in women undergoing routine antenatal care in the third trimester.Design: Prospective cohort.

Predictive utility of the fetal cerebroplacental ratio for hypoxic ischaemic encephalopathy, severe neonatal morbidity and perinatal mortality in late‐preterm and term infants

“…Our results showing that a low CPR is associated with an increased risk of SNM are consistent with previous publications, demonstrating that the CPR is associated with a range of poor perinatal outcomes such as acidosis, intrapartum fetal compromise, admission to the NICU, stillbirth and adverse neurological sequelae in childhood 29–32 . Our findings of a lack of significant association between a low CPR and PNM after adjustment for confounders are in keeping with a large prospective study published in 2019 17 that demonstrated that although a low CPR was associated with adverse perinatal outcome (defined as a composite of stillbirth, neonatal death or HIE), the addition of the CPR contributed little in regard to prediction of adverse outcomes over and above that determined by maternal demographics and medical history.…”

Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low‐income setting

“…Perinatal and maternal outcomes were assessed at the time of birth and up to 28 days postnatally. Additional information on the EPID study is published elsewhere [12][13][14] . All women recruited to the main prospective cohort provided informed and written consent, with illiterate participants signing using a thumbprint.…”

Fetal movement trials: Where is the evidence in settings with a high burden of stillbirths?

“…Although such strategies or their evidence base are often lacking in LMICs, there is some evidence about possible low‐cost diagnostic approaches to assess fetal risk following reduced FM: for example, measuring maternal blood pressure, fetal heart rate and fundal height, 13 or antenatal (handheld) ultrasound to detect and monitor high‐risk pregnancies. Measuring fetal blood flow in Doppler ultrasound studies has also been useful, particularly in detecting growth restriction 6,14 . Involving women and health workers in studies will ensure the consideration of health‐system constraints and allow these to be embedded in the design, implementation and evaluation of any new intervention.…”

“…Measuring fetal blood flow in Doppler ultrasound studies has also been useful, particularly in detecting growth restriction. 6 , 14 Involving women and health workers in studies will ensure the consideration of health‐system constraints and allow these to be embedded in the design, implementation and evaluation of any new intervention. If proven effective, this will increase the chance of the seamless integration of the intervention into existing care, and positive perceptions by providers and pregnant women, and will not increase the burden on already overwhelmed healthcare workers.…”