FETAL CEREBRAL DOPPLER STUDIES AS A PREDICTOR OF PERINATAL OUTCOME AND SUBSEQUENT NEUROLOGIC HANDICAP

Objective: To study the use of middle cerebral arterial Doppler findin gs in a group of high-risk fetuses as a predictor of adverse perinatal outcome, including subsequent neurologic handicap. Methods: A group o f very high-risk fetuses was recruited over a 2-year period for study. Weekly fetal biometries and Doppler studies of the umbilical artery a nd middle cerebral arteries were carried out until delivery. Main outc ome indices analyzed included birth weight ratio (ratio of observed bi rth weight to mean birth weight for gestation), days of ventilator req uirement, neonatal intracranial hemorrhage or periventricular leukomal acia, necrotizing enterocolitis, and follow-up data on major neurologi c handicap and death. Results: Seventy-four patients were recruited. O ne hundred thirty-four sets of examinations were made and prospective follow-up data were available for up to 2 years. The ratio of the umbi lical and middle cerebral arterial resistance index was found to be in versely proportional to the birth weight ratio. Fetuses who had a high prenatal umbilical-cerebral Doppler ratio had significantly lower bir th weight ratios than those with normal findings (0.72 versus 0.92; P < .001) The ratio was a more sensitive marker for growth restriction ( sensitivity 78%) than conventional fetal biometry and umbilical arteri al systolic-diastolic ratio. However, fetuses with high ratios did not have higher incidences of perinatal complications or subsequent neuro logic handicap. Conclusion: Prenatal cerebral vasodilation is a sensit ive marker for growth restriction and it seems to be a physiologic res ponse to hypoxia. Fetuses with intrauterine cerebral vasodilation do n ot have increased risk for subsequent gross neurologic damage.