Utility of Doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses

• Authors: Michał Migda , Katarzyna Gieryn , Bartosz Migda , Marian Stanisław Migda , Marek Maleńczyk

Title variants

PL

Przydatność parametrów dopplerowskich w 36.–42. tygodniu ciąży jako predyktorów nieprawidłowego stanu okołoporodowego u płodów z masą odpowiednią dla wieku ciążowego

• Languages of publication: EN

Abstracts

EN

Aim: To investigate the potential value of Doppler ultrasound and to assess cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome defined as Apgar score < 7 at 1 minute. Material and methods: This was a retrospective cross-sectional study in selected pregnant women undergoing an ultrasound examination between 36 and 42 weeks of gestation. We measured estimated fetal weight (EFW), mean umbilical artery pulsatility index (UA PI), mean middle cerebral artery pulsatility index (MCA PI), CPR, and Apgar score in 1 minute. Multiples of medians (MoM) were calculated for MCA PI and UA PI. Results: The study group consisted of 446 women, 236 were primipara and 210 were multipara. The average age was 29.6 years (range 16–46 years). The average week of delivery is 39.5 weeks of gestation (range 36–42). Mean MCA PI and UA PI were 1.3 (0.1–2.45) and 0.8 (0.39–1.66), respectively. The mean values were 1.03 (0.1–1.9) for MCA PI MoM and 1.04 (0.5–2.1) for UA PI MoM. Primiparas had lower values of MCA PI (1.27 vs. 1.34), MCA PI MoM (1.00 vs. 1.05), CPR (1.62 vs. 1.73), EFW (3479.53 g vs. 3579.25 g) and birth weight (3513.50 g vs. 3617.79 g). For CPR cut-off point of 1.08: sensitivity was (0.945), specificity 0.1, positive predictive values 0.979, negative predictive values 0.04 and accuracy 0.926. The ROC curves for CPR were: area under the curve was 0.52 at CI 95% (0.342–0.698), p = 0.8271. Conclusion: Screening in pregnancies with appropriate-for-gestational-age fetuses at 36–42 weeks of gestation using Doppler parameters is not useful in the prediction of adverse perinatal outcomes like an Apgar score < 7 at 1 minute.

PL

Cel pracy: Zbadanie przydatności badania dopplerowskiego oraz współczynnika mózgowo-pępowinowego (CPR) w przewidywaniu powikłań okołoporodowych zdefiniowanych jako wynik w skali Apgar <7 punktów w 1. minucie po urodzeniu. Materiał i metody: Niniejsze badanie przekrojowe miało charakter retrospektywny. Objęło kobiety ciężarne poddawane badaniu USG pomiędzy 36. a 42. tygodniem ciąży. Rejestrowane parametry to: szacunkowa masa ciała płodu (EFW), średnia wartość wskaźnika pulsacji tętnicy pępowinowej (UA PI), średnia wartość wskaźnika pulsacji tętnicy środkowej mózgu (MCA PI), CPR oraz punktacja w skali Apgar w 1. minucie po urodzeniu. Obliczano też wielokrotności mediany (MoM) MCA PI oraz UA PI. Wyniki: Grupa objęta badaniem składała się łącznie z 446 kobiet, w tym 236 pierworódek oraz 210 wieloródek. Średnia wieku uczestniczek badania wynosiła 29,6 roku (zakres 16–46 lat). Średnia wieku ciążowego, w którym następowało rozwiązanie, wynosiła 39,5 tygodnia (zakres 36–42 tygodni). Średnie wartości MCA PI i UA PI wynosiły odpowiednio 1,3 (0,1–2,45) oraz 0,8 (0,39–1,66). Średnie wartości MoM wynosiły dla MCA PI 1,03 (0,5–2,1), a dla UA PI 1,04 (0,5–2,1). U pierworódek stwierdzono niższe wartości wskaźnika MCA PI (1,27 vs 1,34), MCA PI MoM (1,00 vs 1,05), CPR (1,62 vs 1,73), EFW (3479,53 g vs 3579,25 g) oraz urodzeniowej masy ciała (3513,50 g vs 3617,79 g). Dla CPR przy punkcie odcięcia równym 1,08 czułość wynosiła 0,945, swoistość 0,1, wartość predykcyjna dodatnia 0,979, wartość predykcyjna ujemna 0,04, dokładność 0,926. Krzywe ROC dla CPR kształtowały się następująco: pole pod krzywą wynosiło 0,52 przy 95-procentowym przedziale ufności (0,342–0,698), p = 0,8271. Wnioski: Badanie przesiewowe z wykorzystaniem parametrów dopplerowskich nie jest pomocne w przewidywaniu powikłań okołoporodowych, takich jak wynik Apgar <7 w 1. minucie po urodzeniu, w ciążach, w których masa ciała płodu odpowiada wiekowi ciążowemu pomiędzy 36. a 42. tygodniem ciąży. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/issues/volume-18-no-72

Keywords

EN

appropriate-forgestational-age; middle cerebralartery Doppler; third trimesterscreening; umbilical arteryDoppler

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2018
• Volume: 18
• Issue: 72
• Pages: 22–28

Contributors

author

Michał Migda

• Obstetrics, Women’s Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland; Civis Vita Medical Center in Toruń, Poland

author

Katarzyna Gieryn

• Obstetrics, Women’s Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland

author

Bartosz Migda

• Diagnostic Imaging Division, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland

author

Marian Stanisław Migda

• Civis Vita Medical Center in Toruń, Poland

author

Marek Maleńczyk

• Obstetrics, Women’s Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland

References

• 1. Ropacka-Lesiak M, Korbelak T, Świder-Musielak J, Breborowicz G: Cerebroplacental ratio in prediction of adverse perinatal outcome and fetal heart rate disturbances in uncomplicated pregnancy at 40 weeks and beyond. Arch Med Sci 2015; 11: 142–148.
• 2. Akolekar R, Syngelaki A, Gallo DM, Poon LC, Nicolaides KH: Umbilical and fetal middle cerebral artery Doppler at 35–37 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2015; 46: 82–92.
• 3. Prior T, Mullins E, Bennett P, Kumar S: Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study. Am J Obstet Gynecol 2013; 208: 124.e1–124.e6.
• 4. Shwarzman P, Waintraub AY, Frieger M, Bashiri A, Mazor M, Hershkovitz R: Third-trimester abnormal uterine artery Doppler findings are associated with adverse pregnancy outcomes. J Ultrasound Med 2013; 32: 2107–2113.
• 5. Khalil AA, Morales-Rosello J, Elsaddig M, Khan N, Papageorghiou A, Bhide A et al.: The association between fetal Doppler and admission to neonatal unit at term. Am J Obstet Gynecol 2015; 213: 57.e1–57.e7.
• 6. Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A et al.: Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015; 213: 54.e1–54.e10.
• 7. Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T: Reference ranges for serial measurements of blood velocity and pulsatility index at the intra-abdominal portion, and fetal and placental ends of the umbilical artery. Ultrasound Obstet Gynecol 2005; 26: 162–169.
• 8. Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A: Cerebralumbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79: 416–420.
• 9. Cruz-Martínez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E: Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011; 117: 618–626.
• 10. Valiño N, Giunta G, Gallo DM, Akolekar R, Nicolaides KH: Biophysical and biochemical markers at 30–34 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2016; 47: 194–202.
• 11. Kwon JY, Kwon HS, Kim YH, Park YW: Abnormal Doppler velocimetry is related to adverse perinatal outcome for borderline amniotic fluid index during third trimester. J Obstet Gynaecol Res 2006; 32: 545–549.
• 12. Bakalis S, Akolekar R, Gallo DM, Poon LC, Nicolaides KH: Umbilical and fetal middle cerebral artery Doppler at 30–34 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2015; 45: 409–420.
• 13. Prior T, Mullins E, Bennett P, Kumar S: Influence of parity on fetal hemodynamics and amniotic fluid volume at term. Ultrasound Obstet Gynecol 2014; 44: 688–692.
• 14. Bakalis S, Silva M, Akolekar R, Poon LC, Nicolaides KH: Prediction of small-for-gestational-age neonates: screening by fetal biometry at 30–34 weeks. Ultrasound Obstet Gynecol 2015; 45: 551–558.
• 15. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, HernandezAndrade E et al.: ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013; 41: 233–239.
• 16. Devine PA, Bracero LA, Lysikiewicz A, Evans R, Womack S, Byrne DW: Middle cerebral to umbilical artery Doppler ratio in post-date pregnancies. Obstet Gynecol 1994; 84: 856–860.
• 17. Palacio M, Figueras F, Zamora L, Jiménez JM, Puerto B, Coll O et al.: Reference ranges for umbilical and middle cerebral artery pulsatility index and cerebroplacental ratio in prolonged pregnancies. Ultrasound Obstet Gynecol 2004; 24: 647–653.
• 18. Akolekar R, Sarno L, Wright A, Wright D, Nicolaides KH: Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 402–408.
• 19. Baschat AA, Gembruch U: The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003; 21: 124–127.
• 20. Korbelak T, Ropacka-Lesiak M, Breborowicz G: [Doppler blood flow velocimetry in the umbilical artery in uncomplicated pregnancy]. Ginekol Pol 2012; 83: 38–45.
• 21. Peixoto AB, Rodrigues da Cunha Caldas TM, Godoy Silva TA, Silva Gomes Caetano MS, Martins WP, Martins Santana EF et al.: Assessment of ultrasound and Doppler parameters in the third trimester of pregnancy as predictors of adverse perinatal outcome in unselected pregnancies. Ginekol Pol 2016; 87: 510–515.
• 22. Abdalla N, Piórkowski R, Stanirowski P, Pazura M, Cendrowski K, Sawicki W: Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors? J Ultrason 2017; 17: 116–122.
• 23. Abidoye IA, Ayoola OO, Idowu BM, Aderibigbe AS, Loto OM: Uterine artery Doppler velocimetry in hypertensive disorder of pregnancy in Nigeria. J Ultrason 2017; 17: 253–258.
• 24. Valiño N, Giunta G, Gallo DM, Akolekar R, Nicolaides KH: Biophysical and biochemical markers at 35–37 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2016; 47: 203–209.

• Document Type: article