The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study

Flood, Karen; Unterscheider, Julia; Daly, Seán; Geary, Michael; Kennelly, Máiréad; McAuliffe, Fionnuala M.; O’Donoghue, Keelin; Hunter, Alyson; Morrison, John J.; Burke, Gerard; Dicker, Patrick; Tully, Elizabeth; Malone, Fergal D.

doi:10.1016/j.ajog.2014.05.008

Cited by 170 publications

(158 citation statements)

References 16 publications

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“…The corresponding specificities were 56-93%, 54-80%, 53-96%, and 53-97%, respectively [62]. Furthermore, the findings of the PORTO study reinforced the importance of CPR in identifying at risk fetuses; FGR fetuses with abnormal CPR had a 11-fold increase in the risk of adverse pregnancy outcomes, in particular neonatal morbidity, when compared to those with normal CPR [59].…”

Section: Fetal Dopplermentioning

confidence: 75%

“…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: 75%

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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“…Longitudinal studies on IUGR babies have recently identified the cephalization index (CI = head circumference/BW) as one of the best perinatal parameters for the prediction of neurodevelopmental outcome (Geva, Eshel, Leitner, Fattal‐Valevski, & Harel, 2006). A high CI in IUGR babies seems to be indicative of intrauterine blood flow redistribution, also known as the brain sparing effect, and is strongly correlated with a reduction in IQ, difficulties in creative problem solving, deficits in attention and executive functions, and alterations in visuomotor organization (Flood et al., 2014; Van den Broek, Kok, Houtzager, & Scherjon, 2010). …”

Section: Introductionmentioning

confidence: 99%

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

et al. 2017

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IntroductionIntrauterine growth restriction (IUGR) is the failure of the fetus to achieve its inherent growth potential, and it has frequently been associated with neurodevelopmental problems in childhood. Neurological disorders are mostly associated with IUGR babies with an abnormally high cephalization index (CI) and a brain sparing effect. However, a similar correlation has never been demonstrated in an animal model. The aim of this study was to determine the correlations between CI, functional deficits in learning and memory and alterations in synaptic proteins in a rat model of IUGR.MethodsUtero‐placental insufficiency was induced by meso‐ovarian vessel cauterization (CMO) in pregnant rats at embryonic day 17 (E17). Learning performance in an aquatic learning test was evaluated 25 days after birth and during 10 days. Some synaptic proteins were analyzed (PSD95, Synaptophysin) by Western blot and immunohistochemistry.ResultsPlacental insufficiency in CMO pups was associated with spatial memory deficits, which are correlated with a CI above the normal range. CMO pups presented altered levels of synaptic proteins PSD95 and synaptophysin in the hippocampus.ConclusionsThe results of this study suggest that learning disabilities may be associated with altered development of excitatory neurotransmission and synaptic plasticity. Although interspecific differences in fetal response to placental insufficiency should be taken into account, the translation of these data to humans suggest that both IUGR babies and babies with a normal birth weight but with intrauterine Doppler alterations and abnormal CI should be closely followed to detect neurodevelopmental alterations during the postnatal period.

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“…The MCA PI less than 5 centile is also an efficient tool for the evaluation of the cerebral vasodilatation. A recent study from 2014 on 881 fetuses with E-IUGR, analyzing the aggregate morbidity and the mortality of IUGR fetuses found that CPR<1 regardless of the evaluation methods, is associated with a poor perinatal outcome (OR=11.7, p<0.001); moreover all three fetal deaths were associated with a CPR<1 [26]. Another finding of the above mentioned study is that MCA can be evaluated using IR or IP, the results being similar [26].…”

Section: E-iugrmentioning

confidence: 77%

“…The abnormal cerebroplacental ratio was found to be superior to biophysical profile in fetuses with E-IUGR for the prediction of adverse pregnancy outcome [27,28] such as higher rates of prematurity, low birth weight, high rate of caesarean section, Apgar score inferior to 7 at 5 minutes, increased rate of fetal acidosis, adverse neonatal outcome, neonatal intensive care unit admission and perinatal death [26,27,29]. Moreover it has been shown that in E-IUGR the CPR is highly correlated with ante and postpartum outcome [27] but there are others studies that demonstrate the superior role of umbilical indices in these cases.…”

Section: E-iugrmentioning

confidence: 96%

The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature.

2016

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Intrauterine growth restriction (IUGR) represents a serious condition that can lead to increased perinatal morbidity, mortality and postnatal impaired neurodevelopment. There are two distinct phenotypes of IUGR: early onset and late onset IUGR with different onset, patterns of evolution and fetal Doppler profile. In early onset preeclampsia the main Doppler modifications are at the level of umbilical artery, with progressive augmentation of the pulsatility index to absent or reverse end diastolic flow. The modifications of the cerebral, cardiac and ductus venosus circulation are generally present, but with different sequences. The late onset IUGR is determined by third trimester placental insufficiency that entails fetal hypoxia. The cerebro-placental ratio (CPR) and the pulsatility index of the middle cerebral artery (PI MCA) seems to be the main markers for both diagnosis and obstetrical management while umbilical Doppler PI is frequently normal. Also the sequence of Doppler alterations is neither specific nor complete. New protocols for the diagnosis and management of late onset IUGR need to be implemented.

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The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study

Cited by 170 publications

References 16 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

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature.

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