Zanco Journal of Medical Sciences
 
Skip Navigation Links
Home
Available Issues
Search
Editorial Board
Information for Authors
Review Process
Copyright
Links and Contacts
  Zanco J Med Sci:  Aug. 2018; 22 (2): 164-171

The value of middle cerebral artery to umbilical artery ratio by Doppler velocimetry in low risk postdate pregnancies

Chro N. Fattah *, Chea Nofel **

 

* Department of Obstetric/Gynecology, College of Medicine, University of Sulaimani, Sulaimani, Iraq.

** Department of Health System, Kirkuk, Iraq.
 


Abstract

Background and objective: Placental insufficiency is the primary cause of intrauterine growth restriction in normally formed fetuses and can be identified using middle cerebral artery to umbilical artery ratio Doppler velocimetry, and provide an estimate of downstream placental vascular resistance and placental blood flow. There is a strong association between reduced end-diastolic umbilical artery blood flow velocity and increased vascular resistance in umbilical placental microcirculation. Doppler ultrasound can assess the uteroplacental blood flow just before labor. This study aimed to investigate the use of the fetal cerebroumbilical ratio to predict the intrapartum fetal compromise in appropriately grown fetuses.

Methods: A comparative cross-sectional study set at Sulaimania Maternity Teaching Hospital, Sulaimania, Iraq, from January to June 2015. The study recruited 121 cases, fetal biometry and Doppler indices were measured before established labor. The intrapartum and neonatal outcome details recorded.

Results: Infants delivered by cesarean section for fetal compromise had significantly lower cerebroumbilical ratio than those born by spontaneous normal (none assisted) vaginal delivery and by cesarean section for other intrapartum causes. Infants with cerebroumbilical ratio <10th percentile were more likely to be delivered by cesarean section for fetal compromised than those with a cerebroumbilical ratio > 10th percentile. A cerebroumbilical ratio >90th percentile appears protective against cesarean section for fetal compromise. Amniotic fluid index of < 5 was associated with an increased cesarean section for fetal indication.

Conclusion The cerebroumbilical ratio can identify fetuses at high risk of intrapartum fetal compromise. As a confounding variable, the amniotic fluid index was a useful tool for surveillance in prolonged pregnancy.

Keywords: Cerebralumbilical ratio; Amniotic fluid index; Doppler; Labour. 


PDF

Reference

1. Bakketeig L, Bergsjo P. Post-term pregnancy – magnitude of the problem. In: Chalmers I, Elkin M, Kierse MJNC (Eds). Effectivecare in pregnancy and childbirth. London: Oxford University Press; 1991. P. 765–75. 

2. Rayburn WF, Chang FE. Management of the    uncomplicated postdate pregnancy. J Reprod Med 1981; 26:93–5.

3. Hollis B. Prolonged pregnancy. Curr Opin Obstet Gynecol 2002; 14:203–7.

4. Clausson B, Cnattingius S, Axelsson O. Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 1999; 94:758–62.

5. Arias F. Predictibility of complications associated with prolongation of pregnancy. Obstet Gynecol 1987; 70:101–6.

6. Shime J, Gare DJ, Andrews J, Prolonged pregnancy: surveillance of the fetus and the neonate and the course of labor and delivery. Am J Obstet Gynecol 1984; 148:547–52.

7. Arias F. Accuracy of middle-cerebral to umbilical artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications. Am J Obstet Gynecol 1994; 171:1541–5.

8. Gramellini D, Folli MC, Raboni S, Cerebral umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79:416–20.

9. Mogren I, Stenlund H, Hogberg U. Recurrence of prolonged pregnancy. Int J Epidemiol 1999; 28:253–257.

10. Antenatal Care, Routine Care for the Healthy Pregnant WomanNICE Clinical Guidelines, No. 62 National Collaborating Centre for Women's and Children's Health (UK). London: RCOG Press; 2008.

11. Roos N, Sahlin L, Ekman-Ordeberg G. Maternal risk factors for postterm pregnancy and cesarean delivery following labor induction. Acta Obstet Gynecol Scand. 2010; 89(8):1003–10.

12. O'Reilly-Green CP. Divon MY. Predictive value of amniotic fluid index for oligohydramnios in patients with prolonged pregnancies. J Matern Fetal Med 1996; 5:218–26.

13. Rainford M. Adair R. Scialli AR. Ghidini A. Spong CY. Amniotic fluid index in the uncomplicated term pregnancy: prediction of outcome. J Reprod Med 2001; 46:589–92.

14. Prior T, Mullins E, Bennett P, Kumar S. Prediction of intrapartum fetal compromise using cerebroumbilica ratio: aprospective observational study. Am J Obstet Gynecol 2013; 208(2):124e1–6.

15. Luesley DM, Baker PN. Obstetrics and Gynecology: An evidence-based text for MRCOG. 2nd ed. London: Hodder Arnold; 2010. P. 381–8.

16. Reddy D. Value of colour Doppler in evaluation of intrauterine growth restriction with clinical correlation. MD thesis in Radiodaignosis. Bangalore, India; Rajiv Gahndi University of Health Sciences: 2008.

17. Maulik D, Yarlagadda P, Downing G. Doppler velocimetry in obstetrics. Obstet Gynecol 1989; 32:628–44.

18. Madazli R, Uluda─č S, Ocak V. Doppler assessment of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction. Acta Obstet Gynecol Scand 2001; 80(8):702–7.

19. Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, Mari G. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999; 180(3 Pt 1):750–6.

20. Callen PW. Callen ultrasonography in obstetrics and gynecology. 4th ed., Philadelphia: Saunders; 2000. P. 686–92.

21. Ferrazzi E, Pardi G, Bauscaglia M, Marconi AM, Gementi B, Bellotti M, et al. The correlation of biochemical monitoring versus umbilical flow velocity measurements of the humanfetus. Am J Obstet Gynecol 1988; 159:1081–7.

22. Farrell T, Chien PF, Gordon A. Intrapartum umbilical artery Doppler velocimetry as a predictor of adverse perinatal outcome: a systematic review. Br J Obstet Gynaecol 1999; 106:783–92.

23. Bahado- Singh RO, Kovanci E, Jeffres A, Oz U, DerenO, Copel J, Mari G. The Doppler cerebroumbilical ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999;180(3,1):750–6.

24. Bindu T. Cerebral and umbilical arterial blood flow velocity in normal and growth retarded pregnancy. MSc thesis in Obstetrics and Gynecology. Bangalore, India: Rajiv Gandhi University of Health Sciences; 2012.

25. Lam H, Leung WC, Lee CP, Lao TT. The use of fetal Doppler cerebroplacental blood flow and amniotic fluid volume measurement in the surveillance of postdated pregnancies. Acta Obstet Gynecol Scand 2005; 84:844–8.

26. Mishra D, Sakhi D, Saraf D, Gupta D, Soni D, Dhruwr D. Role of Obstetric Doppler in Prediction of Adverse Perinatal Outcome in Intrauterine Growth Retardation and Pregnancy Induced Hypertension. SJAMS 2013; 1(6):1016–20.

27. Rajesh M, Agamya S.Role of Colour Doppler Indices in the Diagnosis of Intrauterine Growth Retardation in High-Risk Pregnancies. The Journal of Obstetrics and Gynecology of India 2013; 63(1):37–44.

28. Palacio M, Figueras F, Zamora L, Jiménez JM, Puerto B, Coll O, et al. Reference ranges for umbilical and middle ceretral artery pulsatility index and cerebroplacental ratio in prolonged pregnancies. Ultrasound Obstet Gynecol 2004: 24:647–53.

29. 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; 84:856–60.