The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction

Bahado‐Singh, Ray O.; Kovancı, Ertuğ; Jeffres, Andrea; Öz, Utku; Deren, Özgür; Copel, Joshua A.; Mari, Giancarlo

doi:10.1016/s0002-9378(99)70283-8

Cited by 299 publications

(261 citation statements)

References 19 publications

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“…The finding of an increasing incidence of growth restriction and asymmetric growth at more advanced GA and with longer expectant management is in line with other studies 4,5 and is of concern since both have been identified as predictors of survival in previous studies 5 and indicated poorer outcome in this cohort ( 16,20,33,34 the placentocerebral ratio preceding delivery was higher in pregnancies with poor outcome or major morbidity and showed a stronger association than middle cerebral artery PI alone. When controlling for the fetal weight estimation, the placentocerebral ratio was no longer significantly associated with the end points studied.…”

Section: Redistributionsupporting

confidence: 89%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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Section: Redistributionsupporting

confidence: 89%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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“…19,20 The CPR offers the advantage of detecting redistribution of flow and has been shown to be more predictive of adverse perinatal outcome in growth-restricted fetuses than UA or MCA Doppler values alone. 9,21 Baschat and Gembruch have published a gestational age-based CPR nomogram which was validated in a study by Odibo et al, who furthermore confirmed that a categorical CPR value of less than 1.08 was predictive of adverse perinatal outcome in infants with intrauterine growth retardation. [20][21][22][23] We hypothesized that this assessment of fetal wellbeing, currently used in cases of elevated placental resistance, could also be applied to situations of diminished cardiac output secondary to bradycardia.…”

Section: Discussionmentioning

confidence: 91%

“…16 Doppler investigation of regional fetal circulation can provide information regarding fetal well-being and has been evaluated in a number of conditions including intrauterine growth retardation and preeclampsia, where the particular focus has been on relative changes in cerebral and umbilical blood flow resistances. 9,17,18 A beneficial, autoregulatory brain sparing effect from a decrease in middle cerebral arterial resistance improves oxygen delivery to the brain in the presence of increased umbilical artery resistance. This effect is likely due to two potential mechanisms: 'forced centralization' from elevated placental resistance; and a decrement in cerebral arterial resistance.…”

Section: Discussionmentioning

confidence: 99%

“…10 The CPR was computed as the ratio of the MCA-PI to the UA-PI. 9 We reviewed the prenatal and postnatal clinical course of each patient. All fetuses had middle cerebral artery Doppler interrogations available from the fetal echocardiogram performed before their delivery, and two fetuses had serial data from the time of diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…7,8 The cerebroplacental Doppler ratio (CPR), defined as the ratio of the middle cerebral artery pulsatility index (MCA-PI) to the umbilical artery pulsatility index (UA-PI), is a measure of redistribution of cardiac output, and it is predictive of adverse perinatal outcome in growth-restricted fetuses where there is altered umbilical artery resistance and fetal hypoxia. 9 We hypothesize that the CPR will also be predictive of fetal outcome in cases where there is the potential for diminished cardiac output secondary to complete heart block. We present a case series of patients diagnosed prenatally with autoimmune-mediated CCHB in which the CPR was assessed, and propose that this index be used to help identify those at risk of cardiovascular compromise before the onset of overt ventricular failure, hydrops, fetal distress or death.…”

Section: Introductionmentioning

confidence: 99%

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The cerebroplacental Doppler ratio predicts postnatal outcome in fetuses with congenital heart block

et al. 2008

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Objective: Autoimmune-mediated congenital complete heart block (CCHB) is associated with significant perinatal morbidity and mortality, and prenatal monitoring of these fetuses is a significant challenge. The cerebroplacental Doppler ratio (CPR), defined as the ratio of the middle cerebral artery pulsatility index (MCA-PI) to the umbilical artery pulsatility index (UA-PI), is predictive of perinatal outcome in growth-restricted fetuses. This study tests the hypothesis that the CPR would be useful in monitoring fetal well-being in fetuses with CCHB.Study Design: We reviewed data on all patients diagnosed prenatally with autoimmune-mediated CCHB at our institution over the past 2 years. The fetal echocardiograms from each patient were analyzed for: CPR, UA-PI, MCA-PI, cardiothoracic ratio, degree of tricuspid regurgitation, ventricular function and presence of effusions. We compared hemodynamic data from the fetal echocardiogram before delivery in patients who required urgent pacemaker placement postnatally to those patients that did not require an urgent pacemaker.Result: Five patients with autoimmune-mediated CCHB were identified, and two patients required urgent pacemaker placement. The CPR before delivery was significantly lower in the patients who required urgent pacemaker placement (0.97±0.06 versus 1.45±0.03; P ¼ 0.003), but there was no difference in other fetal echocardiographic markers between groups. Both patients requiring urgent pacemaker placement had a CPR less than 1.08. Conclusion:The CPR is predictive of postnatal outcome in fetuses with CCHB and is useful in prenatal monitoring of these patients.

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Abnormal fetal cerebral and umbilical doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity

Sterne

Shields

Dubinsky

2001

J. Clin. Ultrasound

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The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction

Cited by 299 publications

References 19 publications

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

The cerebroplacental Doppler ratio predicts postnatal outcome in fetuses with congenital heart block

Abnormal fetal cerebral and umbilical doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity

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