Prognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

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Abstract

Objective. To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR). Design. Cohort study. Setting. Third-level Perinatology Center in Northern Italy. Population. A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements. Methods. FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage. Main outcome measures. Perinatal death and neonatal brain damage. Results. The prevalence of fetal/neonatal death or brain damage was 18.2% (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2% (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95% confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95% CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95% CI=0.02-6.13, Synergy index=27.7, p=0.007). Conclusions. In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.

Original languageEnglish
Pages (from-to)159-166
Number of pages8
JournalActa Obstetricia et Gynecologica Scandinavica
Volume88
Issue number2
DOIs
Publication statusPublished - 2009

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Umbilicus
Umbilical Arteries
Rheology
Middle Cerebral Artery
Fetal Development
Pregnancy
Fetal Death
Brain
Gestational Age
Perinatology
Vasodilation
Italy
Cohort Studies
Logistic Models
Outcome Assessment (Health Care)
Perinatal Death
Confidence Intervals
Hemorrhage
Population

Keywords

  • Fetal growth restriction
  • Middle cerebral artery
  • Neonatal mortality
  • Umbilical artery

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{ae6bc5b67d674934ae7a3b905cd43e84,
title = "Prognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction",
abstract = "Objective. To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR). Design. Cohort study. Setting. Third-level Perinatology Center in Northern Italy. Population. A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements. Methods. FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage. Main outcome measures. Perinatal death and neonatal brain damage. Results. The prevalence of fetal/neonatal death or brain damage was 18.2{\%} (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2{\%} (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95{\%} confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95{\%} CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95{\%} CI=0.02-6.13, Synergy index=27.7, p=0.007). Conclusions. In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.",
keywords = "Fetal growth restriction, Middle cerebral artery, Neonatal mortality, Umbilical artery",
author = "Arsenio Spinillo and Laura Montanari and Marianna Roccio and Silvia Zanchi and Chryssoula Tzialla and Mauro Stronati",
year = "2009",
doi = "10.1080/00016340802632358",
language = "English",
volume = "88",
pages = "159--166",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley-Blackwell",
number = "2",

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TY - JOUR

T1 - Prognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

AU - Spinillo, Arsenio

AU - Montanari, Laura

AU - Roccio, Marianna

AU - Zanchi, Silvia

AU - Tzialla, Chryssoula

AU - Stronati, Mauro

PY - 2009

Y1 - 2009

N2 - Objective. To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR). Design. Cohort study. Setting. Third-level Perinatology Center in Northern Italy. Population. A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements. Methods. FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage. Main outcome measures. Perinatal death and neonatal brain damage. Results. The prevalence of fetal/neonatal death or brain damage was 18.2% (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2% (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95% confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95% CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95% CI=0.02-6.13, Synergy index=27.7, p=0.007). Conclusions. In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.

AB - Objective. To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR). Design. Cohort study. Setting. Third-level Perinatology Center in Northern Italy. Population. A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements. Methods. FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage. Main outcome measures. Perinatal death and neonatal brain damage. Results. The prevalence of fetal/neonatal death or brain damage was 18.2% (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2% (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95% confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95% CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95% CI=0.02-6.13, Synergy index=27.7, p=0.007). Conclusions. In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.

KW - Fetal growth restriction

KW - Middle cerebral artery

KW - Neonatal mortality

KW - Umbilical artery

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