G. Sterne et al., Abnormal fetal cerebral and umbilical Doppler measurements in fetuses withintrauterine growth restriction predicts the severity of perinatal morbidity, J CLIN ULTR, 29(3), 2001, pp. 146-151
Purpose. This prospective study was performed to determine if the ratio of
the middle cerebral artery (MCA) S/D ratio (ratio of peak systolic blood fl
ow velocity to diastolic velocity) to the umbilical artery (UA) S/D ratio (
MCA/UA S/D ratio) predicts the degree of neonatal morbidity in fetuses susp
ected of having intrauterine growth restriction (IUGR).
Methods. Sixty-one fetuses were identified prospectively by sonography as h
aving an estimated fetal weight below the 10th percentile for gestational a
ge. The 61 fetuses underwent Doppler sonography in the third trimester and
then were stratified into 3 groups based on the MCA/UA S/D ratio: group A,
MCA/UA S/D ratio > 1.0 (controls; n = 37); group B, MCA/UA S/D ratio less t
han or equal to 1.0 (intracerebral blood flow redistribution; n = 16); and
group C, reversed or absent UA diastolic flow (n = 8). Outcome variables as
sessed included gestational age at delivery, birth weight, UA pH, mode of d
elivery, respiratory distress syndrome requiring intubation, and intracrani
al hemorrhage.
Results. The mean MCA/UA S/D ratios in groups A and B were 1.69 +/- 0.61 an
d 0.59 +/- 0.24, respectively (p < 0.01). The mean gestational ages at deli
very for groups A, B, and C were 34.7, 33.2, and 29.0 weeks, respectively.
The mean birth weights were below the fifth percentile for age for groups B
and C and significantly related to the severity of abnormal Doppler findin
gs (p < 0.01) after correction for age. Mean UA pHs were 7.25 +/- 0.01, 7.1
9 +/- 0.01, and 7.14 +/- 0.13 for groups A, B, and C, respectively, with si
gnificant differences between groups A and B (p < 0.05) and groups A and C
(p < 0.05). Respiratory distress syndrome and intracranial hemorrhage were
not associated with abnormal Doppler findings after correction for gestatio
nal age. The interval between the abnormal Doppler examination and delivery
(p < 0.001) and the occurrence of fetal distress requiring cesarean sectio
n (p < 0.001) were significantly related to the severity of Doppler finding
s.
Conclusions. In fetuses with suspected IUGR, abnormal MCA/UA S/D ratios are
strongly associated with low gestational age at delivery, low birth weight
, and low UA pH. Abnormal MCA/UA S/D ratios are also significantly associat
ed with shorter interval to delivery and the need for emergent delivery. (C
) 2001 John Wiley & Sons, Inc.