The association between fetal Doppler and admission to neonatal unit at term

Khalil, Asma; Elsaddig, Malaz; Khan, Naila Zaman; Papageorghiou, Aris T.; Bhide, A.; Thilaganathan, B.

doi:10.1016/j.ajog.2014.10.013

Cited by 108 publications

(106 citation statements)

References 25 publications

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“…The finding that AGA fetuses with low CPR MoM were likely to exhibit placental insufficiency was also supported by our group in further studies, indicating that these fetuses with lower CPR were at higher risk of low neonatal pH values at birth [2] , admission to the neonatal unit [3] and abnormal uterine Doppler findings suggesting placental underperfusion [4] . Furthermore, other investigators have reported that, prior to the active phase of labor, CPR could identify those fetuses with adverse neonatal outcome [5] .…”

Section: Introductionsupporting

confidence: 67%

Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios

et al. 2015

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Objective: A low cerebro-placental ratio (CPR) at term suggests the existence of failure to reach growth potential (FRGP) with a higher risk of poor neonatal acid-base status. This study aimed to evaluate whether similar findings were also seen in the vertebral artery (vertebro-placental ratio, VPR), supplying 30% of the cerebral flow. Methods: We studied term fetuses classified into groups according to birth weight (BW), CPR and VPR. BW was expressed in centiles and ratios in multiples of the median (MoM). Subsequently, associations with neonatal pH values were evaluated by means of regression curves and Mann-Whitney tests. Results: VPR MoM correlated with BW centiles (p < 0.0001, R² = 0.042) and its distribution resembled that of CPR MoM (p < 0.001). When both arteries were compared, adequate-for-gestational-age (AGA) fetuses with either low CPR or low VPR had lower neonatal venous pH values (p < 0.05, p < 0.01, respectively). However, in case of small-for-gestational-age (SGA) fetuses, only those with low VPR had significantly lower neonatal arterial and venous pH values (p < 0.05). Conclusions: Blood flow in the vertebral artery mimics that in the middle cerebral artery supporting the FRGP model. Both CPR and VPR identify AGA fetuses with lower neonatal pH values, but only VPR identifies SGA with lower pH values. Hypoxemia might be reflected as a generalized cerebral vasodilation demonstrated as low CPR and VPR.

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Section: Introductionsupporting

confidence: 67%

Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios

et al. 2015

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“…In addition, the fact that this association is always higher for venous pH suggests that at least at term the venous pH is probably a better reflection of placental underperfusion than arterial pH [28][29][30] . In summary, our findings suggest that two scenarios may threaten fetal well-being at term: a very low fetal weight and a very low CPR, whose importance seems to surpass that of low fetal weight.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Acid-Base Status in Term Fetuses: Mathematical Models Investigating Cerebroplacental Ratio and Birth Weight

Morales‐Roselló¹,

Khalil²,

Alberola-Rubio³

et al. 2015

Fetal Diagn Ther

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Objective: Cerebroplacental ratio (CPR) is emerging as a marker of fetal hypoxia at term. The aim of this study was to demonstrate graphically the interrelationships among CPR, birthweight (BW), and neonatal pH, and construct 2D and 3D representations of the areas with potential low pH. Methods: This was a retrospective study of 2,927 term fetuses evaluated according to BW and CPR. The outcome was the acid-base status at birth. Multivariate relationships among CPR, BW, and arterial and venous pH were depicted in 3D scattergrams. Subsequently, trend surfaces were calculated and represented in 2D contour graphs. Finally, 3D representations were constructed by smothering pH data using moving average filters. Results: The trend surfaces and the 2D and 3D contour graphs showed the complex association among the three variables. Although pH changed with CPR and BW, the influence of the BW was smaller than the influence of the CPR, with this effect being more evident in the venous than in the arterial pH. Conclusions: Two scenarios threaten fetal well-being at term: a very low birth weight and a very low fetal CPR. Our findings suggest that the importance of fetal hemodynamics in determining the acid-base status at birth surpasses that of fetal weight.

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“…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%

“…We recently reported that the CPR is a marker of failure to reach growth potential and adverse pregnancy outcomes, in both AGA and SGA fetuses [55,56], and this has been discussed in a recent review [63]. Most studies that assessed the utility of CPR in identifying at risk fetuses used point estimates and lacked longitudinal data.…”

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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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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The association between fetal Doppler and admission to neonatal unit at term

Cited by 108 publications

References 25 publications

Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios

Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios

Neonatal Acid-Base Status in Term Fetuses: Mathematical Models Investigating Cerebroplacental Ratio and Birth Weight

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

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