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Golshahi, F., Sahebdel, B., Shirazi, M., Rahimi Sharbaf, F., Aliabadi, H. R., Taghavipour, M., Mousavi Vahed, S. H., Sedighi Darijani, T., & Nezamnia, M. (2022). Relationship between fetal middle cerebral artery pulsatility index and cerebroplacental ratio with adverse neonatal outcomes in low-risk pregnancy candidates for elective cesarean section: A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 20(8), 663–670. https://doi.org/10.18502/ijrm.v20i8.11755
https://doi.org/10.18502/ijrm.v20i8.11755
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authors
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Fatemeh Golshahi
Fatemeh Golshahi
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Behrokh Sahebdel
Behrokh Sahebdel
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Mahboobeh Shirazi
Mahboobeh Shirazi
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Fatemeh Rahimi Sharbaf
Fatemeh Rahimi Sharbaf
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Hossein Rezaei Aliabadi
Hossein Rezaei Aliabadi
School of Medicine, Bam University of Medical Sciences, Bam, Iran.
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Mona Taghavipour
Mona Taghavipour
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Seyede Houra Mousavi Vahed
Seyede Houra Mousavi Vahed
Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran.
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Tayebeh Sedighi Darijani
Tayebeh Sedighi Darijani
School of Medicine, Ayatollah Kashani Hospital, Jiroft University of Medical Sciences, Jiroft, Iran.
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Maria Nezamnia
Maria Nezamnia
Maternal, Fetal, and Neonatal Research Center, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Published Date
- Sep 6, 2022
Relationship between fetal middle cerebral artery pulsatility index and cerebroplacental ratio with adverse neonatal outcomes in low-risk pregnancy candidates for elective cesarean section: A cross-sectional study
Abstract
Background: The cerebroplacental ratio (CPR) is an important factor for predicting adverse neonatal outcomes in appropriate-for-gestational-age fetuses.
Objective: To evaluate whether there is an association between the CPR level and adverse neonatal outcomes in appropriate-for-gestational-age fetuses.
Materials and Methods: This cross-sectional study included 150 low-risk pregnant women candidates for elective cesarean sections at the gestational age of 39 wk. CPR and middle cerebral artery pulsatility index (MCA PI) were calculated in participants just before cesarian section. Postnatal complications were defined as an adverse neonatal outcome such as an Apgar score of the neonate ≤ 7 at 5 min, neonatal intensive care unit (NICU) admission, cord arterial pH ≤ 7/14, and meconium stained liquor.
Results: The mean age of participants was 31.53 ± 4.91 yr old. The mean CPR was reported as 1.83 ± 0.64. The Chi-square test analysis revealed that a low MCA PI and a low CPR were significantly associated with decreased cord arterial pH, decreased Apgar score at 5 min, and NICU admission (p < 0.001). There was no significant association between umbilical artery PI with arterial cord pH, Apgar score at 5 min, NICU admission, or meconium stained liquor. The Mann-Whitney test showed that a lower fetal weight appropriate for the women’s gestational age was significantly associated with a decreased CPR and MCA PI (p < 0.005). There was no significant association between amniotic fluid index and CPR, umbilical artery PI, or MCA PI.
Conclusion: The CPR is a significant factor in predicting adverse neonatal outcomes and ultimately neonatal mortality and morbidity of low risk, appropriate-for-gestationalage fetuses.
Key words: Umbilical cord blood, Color Doppler ultrasonography, Gestational age.
References
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[16] Acharya G, Wilsgaard T, Berntsen G, Maltau J, 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.
[17] Karlsen HO, Ebbing C, Rasmussen S, Kiserud T, Johnsen SL. Use of conditional centiles of middle cerebral artery pulsatility index and cerebroplacental ratio in the prediction of adverse perinatal outcomes. Acta Obstet Gynecol Scand 2016; 95: 690–696.
[18] Monteith C, Flood K, Mullers S, Unterscheider J, Breathnach F, Daly S, et al. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol 2017; 216: 285.
[19] Ghosh S, Mohapatra K, Samal S, Nayak P. Study of Doppler indices of umbilical artery and middle cerebral artery in pregnancies at and beyond forty weeks of gestation. Int J Reprod Contracept Obstet Gynecol 2016; 5: 4174–4180.
[20] Sirico A, Diemert A, Glosemeyer P, Hecher K. Prediction of adverse perinatal outcome by cerebroplacental ratio. adjusted for estimated fetal weight. Ultrasound Obstet Gynecol 2018; 51: 381–386.
[21] D’Antonio F, Rizzo G, Gustapane S, Buca D, Flacco. ME, Martellucci C, et al. Diagnostic accuracy of Doppler. ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study. Acta Obstet Gynecol Scand 2020; 99: 42–47.
[22] Bonnevier A, Maršál K, Brodszki J, Thuring A, Källén K. Cerebroplacental ratio as predictor of adverse perinatal outcome in the third trimester. Acta Obstet Gynecol Scand 2021; 100: 497–503.
[23] 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.
[24] Anand Sh, Mehrotra S, Singh U, Solanki V, Agarwal S. Study of association of fetal cerebroplacental ratio with adverse perinatal outcome in uncomplicated term AGA pregnancies. J Obstet Gynecol India 2020; 70: 485–489.
[25] Jamal A, Marsoosi V, Sarvestani F, Hashemi N. The correlation between the cerebroplacental ratio and fetal arterial blood gas in appropriate-for-gestational-age fetuses: A cross-sectional study. Int J Reprod Biomed 2021; 19: 821–826.
[26] Buca D, Rizzo G, Gustapane S, Mappa I, Leombroni. M, Bascietto F, et al. Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age fetuses: A prospective study. Ultraschall Med 2021; 42: 404–410.
[2] The American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 134: Fetal growth restriction. Obstet Gynecol 2013; 121: 1122–1133.
[3] Turner JM, Mitchell MD, Kumar SS. The physiology of intrapartum fetal compromise at term. Am J Obstet Gynecol 2020; 222: 17–26.
[4] Lausman A, Kingdom J, Gagnon R, Basso M, Bos H, Crane J, et al. Intrauterine growth restriction: Screening, diagnosis, and management. J Obstet Gynaecol Can 2013; 35: 741–748.
[5] Leung TY, Lao TT. Timing of caesarean section according to urgency. Best Pract Res Clin Obstet Gynaecol 2013; 27: 251–267.
[6] Flood K, Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, et al. The role of brain sparing in. the prediction of adverse outcomes in intrauterine growth restriction: Results of the multicenter PORTO study. Am J Obstet Gynecol 2014; 211: 288.
[7] Vannuccini S, Bocchi C, Severi FM, Petraglia F. Diagnosis of fetal distress. In: Buonocore G, Bracci R, Weindling M. Neonatology. Germany; Springer: 2016.
[8] Everett TR, Peebles DM. Antenatal tests of fetal wellbeing. Semin Fetal Neonatal Med 2015; 20: 138–143.
[9] Vintzileos AM, Smulian JC. Decelerations, tachycardia, and decreased variability: Have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia? Am J Obstet Gynecol 2016; 215: 261–264.
[10] Steller JG, Gumina D, Driver C, Galan HL, Hobbins J, Reeves S. Patterns of brain sparing in a fetal growth restriction (FGR) cohort. Am J Obstet Gynecol 2020; 222 (Suppl.): S85.
[11] Dall’Asta A, Ghi T, Rizzo G, Cancemi A, Aloisio F, Arduini D, et al. Cerebroplacental ratio assessment in early labor in uncomplicated term pregnancy and prediction of adverse perinatal outcome: Prospective multicenter study. Ultrasound Obstet Gynecol 2019; 53: 481–487.
[12] Akolekar R, Ciobanu A, Zingler E, Syngelaki A, Nicolaides KH. Routine assessment of cerebroplacental ratio at 35– 37 weeks’ gestation in the prediction of adverse perinatal outcome. Am J Obstet Gynecol 2019; 221: 65.
[13] Pruetz JD, Votava-Smith J, Miller DA. Clinical relevance of fetal hemodynamic monitoring: Perinatal implications. Semin Fetal Neonatal Med 2015; 20: 217–224.
[14] DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015; 213: 5–15.
[15] Owen J, Albert PS, Louis GMB, Fuchs KM, Grobman WA, Kim S, et al. A contemporary amniotic fluid volume chart for the United States: The NICHD fetal growth studiessingletons. Am J Obstet Gynecol 2019; 221: 67.
[16] Acharya G, Wilsgaard T, Berntsen G, Maltau J, 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.
[17] Karlsen HO, Ebbing C, Rasmussen S, Kiserud T, Johnsen SL. Use of conditional centiles of middle cerebral artery pulsatility index and cerebroplacental ratio in the prediction of adverse perinatal outcomes. Acta Obstet Gynecol Scand 2016; 95: 690–696.
[18] Monteith C, Flood K, Mullers S, Unterscheider J, Breathnach F, Daly S, et al. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol 2017; 216: 285.
[19] Ghosh S, Mohapatra K, Samal S, Nayak P. Study of Doppler indices of umbilical artery and middle cerebral artery in pregnancies at and beyond forty weeks of gestation. Int J Reprod Contracept Obstet Gynecol 2016; 5: 4174–4180.
[20] Sirico A, Diemert A, Glosemeyer P, Hecher K. Prediction of adverse perinatal outcome by cerebroplacental ratio. adjusted for estimated fetal weight. Ultrasound Obstet Gynecol 2018; 51: 381–386.
[21] D’Antonio F, Rizzo G, Gustapane S, Buca D, Flacco. ME, Martellucci C, et al. Diagnostic accuracy of Doppler. ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study. Acta Obstet Gynecol Scand 2020; 99: 42–47.
[22] Bonnevier A, Maršál K, Brodszki J, Thuring A, Källén K. Cerebroplacental ratio as predictor of adverse perinatal outcome in the third trimester. Acta Obstet Gynecol Scand 2021; 100: 497–503.
[23] 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.
[24] Anand Sh, Mehrotra S, Singh U, Solanki V, Agarwal S. Study of association of fetal cerebroplacental ratio with adverse perinatal outcome in uncomplicated term AGA pregnancies. J Obstet Gynecol India 2020; 70: 485–489.
[25] Jamal A, Marsoosi V, Sarvestani F, Hashemi N. The correlation between the cerebroplacental ratio and fetal arterial blood gas in appropriate-for-gestational-age fetuses: A cross-sectional study. Int J Reprod Biomed 2021; 19: 821–826.
[26] Buca D, Rizzo G, Gustapane S, Mappa I, Leombroni. M, Bascietto F, et al. Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age fetuses: A prospective study. Ultraschall Med 2021; 42: 404–410.