Open AccessPrognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction
Author(s) -
SPINILLO ARSENIO,
MONTANARI LAURA,
ROCCIO MARIANNA,
ZANCHI SILVIA,
TZIALLA CHRYSSOULA,
STRONATI MAURO
Publication year - 2009
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340802632358
Subject(s) - medicine , middle cerebral artery , umbilical artery , periventricular leukomalacia , gestational age , fetus , population , obstetrics , intraventricular hemorrhage , laser doppler velocimetry , cardiology , pregnancy , blood flow , ischemia , environmental health , biology , genetics
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.