DOI: https://doi.org/10.22263/2312-4156.2019.1.39
Famina M.P.1, Mackevich N.V.2
The prognostic value of 2D dopplerography of fetoplacental blood flow for perinatal outcomes in fetus growth restriction
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk City Clinical Maternity Hospital No.2, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(1):39-45.
Abstract.
Objectives. To identify the prognostic Doppler parameters of the fetoplacental blood flow after 32 weeks of gestation associated with unfavorable perinatal outcomes and pathological acid-base condition of the newborns’ blood for determining the optimal time of delivery in intrauterine growth restriction.
Material and methods. The resistance indices of the umbilical artery (RIUA), the middle cerebral artery (RIMCA) and cerebroplacental ratio (CPR) after 32-40 weeks of gestation were studied in 71 women with fetus growth restriction (the main group) and 21 women who gave birth to healthy full-term babies (the control group). The acid-base state of the blood was studied in 5-8 minutes of newborns’ life.
Results. It has been established that for the detection of fetal acidosis after 32 weeks of gestation in case of intrauterine growth restriction the values of RIMCA<5% and CPR<1 are diagnostically informative.
Conclusions. The registration of RIMCA<5% with CPR>1 after 32 weeks of gestation in case of intrauterine growth restriction requires daily fetal monitoring, but when 2D Doppler signs of blood circulation centralization (CPR<1 with RIMCA<5%) appear, the delivery after 34 weeks is necessary.
Key words: 2D dopplerography, fetoplacental blood flow, acid-base state of the blood.
References
1. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no.134: fetal growth restriction. Obstet Gynecol. 2013 May;121(5):1122-33. doi: http://dx.doi.org/10.1097/01.AOG.0000429658.85846.f9
2. Lausman A, Kingdom J; Maternal fetal medicine committee. Intrauterine growth restriction: screening, diagnosis, and management. J Obstet Gynaecol Can. 2013 Aug;35(8):741-748. doi: http://dx.doi.org/10.1016/S1701-2163(15)30865-3
3. Thompson RS, Trudinger BJ. Doppler waveform pulsatility index and resistance, pressure and flow in the umbilical placental circulation: an investigation using a mathematical model. Ultrasound Med Biol. 1990;16(5):449-58.
4. Fomina MP, Divakova TS. Ultrasound diagnostics in the assessment of fetal condition in placental disorders and pregnancy management tactics: monografiia. Vitebsk, RB: VGMU; 2016. 369 р. (In Russ.)
5. Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012 Apr;206(4):300-8. doi: http://dx.doi.org/10.1016/j.ajog.2012.01.022
6. Kho EM, North RA, Chan E, Stone PR, Dekker GA, McCowan LM. Changes in Doppler flow velocity waveforms and fetal size at 20 weeks gestation among cigarette smokers. BJOG. 2009 Sep;116(10):1300-6. doi: http://dx.doi.org/10.1111/j.1471-0528.2009.02266.x
7. Trudinger B. Doppler: more or less? Ultrasound Obstet. Gynecol. 2007 Mar;29(3):243-6. doi: http://dx.doi.org/10.1002/uog.3960
8. Eremina, OV, Shifman EM, Baev OR, Aleksandrova NV. Blood examination of the underlying fetus in the assessment of its condition in childbirth. Akusherstvo Ginekologiia. 2011;(8):16-20. (In Russ.)
9. Pal'chik AB, Shabalov NP. Hypoxic ischemic encephalopathy in newborns. 4-e izd ispr i dop. Moscow, RF: MEDpress-inform; 2013. 288 р. (In Russ.)
10. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016 Sep;48(3):333-9. doi: http://dx.doi.org/10.1002/uog.15884
11. Morris RK, Say R, Robson SC, Kleijnen J, Khan KS. Systematic review and meta-analysis of middle cerebral artery Doppler to predict perinatal wellbeing. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):141-55. doi: http://dx.doi.org/10.1016/j.ejogrb.2012.07.027
12. DeVore GR. The importance of the CPR in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015 Jul;213(1):5-15. doi: http://dx.doi.org/10.1016/j.ajog.2015.05.024
13. Dunn L, Sherrell H, Kumar S. Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta. 2017 Jun;54:68-75. doi: http://dx.doi.org/10.1016/j.placenta.2017.02.006
14. Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol. 2015 Oct;46(4):398-404. doi: http://dx.doi.org/10.1002/uog.14818
15. Nassr AA, Abdelmagied AM, Shazly SA. Fetal cerebroplacental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance. J Perinat Med. 2016 Mar;44(2):249-56. doi: http://dx.doi.org/10.1515/jpm-2015-0274
16. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PMM, Mol BWJ, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018 Mar;51(3):313-322. doi: http://dx.doi.org/10.1002/uog.18809
Information about authors:
Famina M.P. – Doctor of Medical Sciences, dean of the Medical Faculty, professor of the Chair of Obstetrics & Gynecology of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
Mackevich N.V. – intern, obstetrician-gynecologist, Vitebsk City Clinical Maternity Hospital No.2.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Obstetrics & Gynecology of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. –Maryna P. Famina.
