1. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?
- Author
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Baskaran Thilaganathan, T. Diehl, A. G. van Wassenaer-Leemhuis, A. Aktas, A T Papageorghiou, Caterina M. Bilardo, Enrico Ferrazzi, R. Chaoui, G. H. A. Visser, Herbert Valensise, J. A. M. van der Post, Jan B. Derks, G. Oggè, J. van Eyck, Neil Marlow, I.K.M. Reiss, Wessel Ganzevoort, Ktm Schneider, M Oberto, A. Skabar, Raffaele Napolitano, U. Maurer-Fellbaum, H. Missfelder-Lobos, John Kingdom, G. Mansi, S. Borgione, Federico Prefumo, Anke Diemert, Tamara Stampalija, E. Lopriore, Gianpaolo Maso, Karel Marsal, Tiziana Frusca, L.S. Scheepers, F. Raimondi, Dietmar Schlembach, Adriana Valcamonico, N. Mensing van Charante, Christoph Lees, Silvia M. Lobmaier, Christoph Brezinka, L. Preston, S. Mulder-de Tollenaer, Pasquale Martinelli, Jim G Thornton, Marc E. A. Spaanderman, J.J. Duvekot, Nicola Fratelli, I.C. van Haastert, N. Weisglas-Kuperus, Dick Oepkes, Kurt Hecher, Hans Wolf, Tullia Todros, E. Ostermayer, Birgit Arabin, A. Zimmermann, Jérôme Cornette, P. Martelli, Other departments, ARD - Amsterdam Reproduction and Development, APH - Quality of Care, Obstetrics and Gynaecology, Other Research, Neonatology, APH - Digital Health, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Stampalija, Tamara, Arabin, Birgit, Wolf, Han, Bilardo, Caterina M., Lees, Christoph, Brezinka, C., Derks, J. B., Diemert, A., Duvekot, J. J., Ferrazzi, E., Frusca, T., Ganzevoort, W., Hecher, K., Kingdom, J., Marlow, N., Marsal, K., Martinelli, P., Ostermayer, E., Papageorghiou, A. T., Schlembach, D., Schneider, K. T. M., Thilaganathan, B., Thornton, J., Todros, T., Valcamonico, A., Valensise, H., van Wassenaer-Leemhuis, A., Visser, G. H. A., Aktas, A., Borgione, S., Chaoui, R., Cornette, J. M. J., Diehl, T., van Eyck, J., Fratelli, N., van Haastert, I. C., Lobmaier, S., Lopriore, E., Missfelder-Lobos, H., Mansi, G., Martelli, P., Maso, G., Maurer-Fellbaum, U., Mensing van Charante, N., Mulder-de Tollenaer, S., Napolitano, R., Oberto, M., Oepkes, D., Ogge, G., van der Post, J. A. M., Prefumo, F., Preston, L., Raimondi, F., Reiss, I. K. M., Scheepers, L. S., Skabar, A., Spaanderman, M., Weisglas-Kuperus, N., Zimmermann, A., Bilardo, Caterina M, Raimondi, Francesco, Reproductive Origins of Adult Health and Disease (ROAHD), and Amsterdam Reproduction & Development (AR&D)
- Subjects
Middle Cerebral Artery ,PREDICTION ,Intrauterine growth restriction ,Umbilical Arteries ,0302 clinical medicine ,Child Development ,cerebroplacental ratio ,Doppler velocimetry ,intrauterine growth restriction ,middle cerebral artery ,neonatal ,umbilicocerebral ratio ,Pregnancy ,RESISTANCE INDEX RATIO ,Obstetrics and Gynaecology ,FOR-GESTATIONAL-AGE ,1114 Paediatrics And Reproductive Medicine ,Birth Weight ,Prenatal ,Cardiotocography ,030212 general & internal medicine ,Prospective Studies ,Child ,Ultrasonography ,RISK ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,medicine.diagnostic_test ,Obstetrics ,Doppler ,Gestational age ,Obstetrics and Gynecology ,Settore MED/40 ,Child, Preschool ,Pulsatile Flow ,Middle cerebral artery ,BLOOD-FLOW PARAMETERS ,Female ,Delivery ,Ductus venosus ,Human ,medicine.medical_specialty ,Delivery, Obstetric ,Gestational Age ,Humans ,Ultrasonography, Doppler ,Ultrasonography, Prenatal ,Preschool ,Obstetric ,03 medical and health sciences ,PULSATILITY INDEX ,FETUSES ,medicine.artery ,SURVEILLANCE ,medicine ,Journal Article ,Obstetrics & Reproductive Medicine ,business.industry ,Umbilical artery ,Odds ratio ,medicine.disease ,Confidence interval ,Prospective Studie ,Umbilical Arterie ,WEIGHT ,business - Abstract
BACKGROUND: Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies.OBJECTIVES: The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26(+0) -31(+6) weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use.STUDY DESIGN: This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26(+0) and 31(+6) weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio.RESULTS: Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal.CONCLUSION: In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26(+0) -31(+6) weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.
- Published
- 2017