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Doppler Study of the Fetal Vertebral Artery in Small for Gestational Age Fetuses With Intrauterine Growth Restriction
Author(s) -
Morales-Roselló José,
Peralta-Llorens Núria
Publication year - 2012
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2012.31.7.1003
Subject(s) - medicine , umbilical artery , percentile , fetus , gestational age , crown rump length , obstetrics , apgar score , intrauterine growth restriction , vertebral artery , small for gestational age , pregnancy , radiology , first trimester , genetics , mathematics , biology , statistics
Objectives The purposes of this study were to evaluate the Doppler resistive index of the fetal vertebral artery in small for gestational age (SGA) fetuses and to examine the ability of the vertebral artery resistive index in the diagnosis of intrauterine growth restriction (IUGR). Methods A total of 437 Doppler examinations of the vertebral and umbilical artery resistive indices were performed in 437 fetuses between 26 and 41 weeks' gestation. According to birth weight, fetuses were classified into 5 groups: 1, above the 10th percentile; 2, between the 10th and 5th percentiles; 3, between the 5th and 3rd percentiles; 4, below the 3rd percentile; and 5, below the 3rd percentile with an umbilical artery resistive index above the 95th percentile. Subsequently, vertebral artery resistive index values were converted into multiples of the median, and box and whisker charts were generated to evaluate differences. Finally, receiver operating characteristic curves were calculated to assess the accuracy of the vertebral artery resistive index for predicting IUGR and a low Apgar score. Results Compared to normally grown fetuses, vertebral artery resistive index values were lower in fetuses with birth weight below the 3rd percentile, and this difference was greater in fetuses with birth weight below the 3rd percentile and Doppler anomalies of the umbilical artery. The receiver operating characteristic analysis showed that the vertebral artery resistive index diagnosed SGA fetuses and low Apgar scores poorly. However, it performed better in cases of severe IUGR with high umbilical artery resistive index values. Conclusions Preliminary data show that the vertebral artery resistive index diminishes in growth‐restricted SGA fetuses. Doppler examination of the vertebral artery seems to identify a group of fetuses with brain sparing and severe IUGR.