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Fetal brain hemodynamics in pregnancies at term: correlation with gestational age, birthweight and clinical outcome.

Authors
  • Ciardulli, Andrea1
  • D'Antonio, Francesco2, 3
  • Caissutti, Claudia4
  • Manzoli, Lamberto5
  • Flacco, Maria Elena6
  • Buongiorno, Silvia1
  • Saccone, Gabriele7
  • Rosati, Paolo1
  • Lanzone, Antonio1
  • Scambia, Giovanni1
  • Berghella, Vincenzo8
  • 1 Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. , (Italy)
  • 2 Women and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway. , (Norway)
  • 3 Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway. , (Norway)
  • 4 Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology, University of Udine, Udine, Italy. , (Italy)
  • 5 Department of Medical Sciences, University of Ferrara, Ferrara, Italy. , (Italy)
  • 6 Department of Medicine and Aging Science, University of Chieti, Chieti, Italy. , (Italy)
  • 7 Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy. , (Italy)
  • 8 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Type
Published Article
Journal
The Journal of Maternal-Fetal & Neonatal Medicine
Publisher
Informa UK (Taylor & Francis)
Publication Date
Mar 01, 2021
Volume
34
Issue
6
Pages
913–919
Identifiers
DOI: 10.1080/14767058.2019.1622669
PMID: 31288578
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The primary aim of this study was to ascertain the strength of association between cerebral blood flow assessed in anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the following clinical outcomes: small for gestational age (SGA), induction of labor (IOL) for oligohydramnios and caesarean section (CS) for nonreassuring fetal status (NRFS) during labor. Retrospective analysis of prospectively collected data on consecutive singleton pregnancies from 40 0/7 to 41 6/7 week of gestation. UA, ACA, MCA, PCA pulsatility index (PI) were measured from 40 weeks of gestations. Furthermore, the ratios between cerebral blood flow and UA (CPR, ACA/UA and PCA/UA) were calculated and correlated with the observed outcomes. Two hundred twenty-four singleton pregnancies were included in the study. Mean PI of either ACA (p = .04), MCA (p = .008), and PCA (p = .003) were lower in the SGA compared to non-SGA group; furthermore, mean PCA PI was significantly lower than MCA PI (p = .04). Furthermore, CPR (p = .016), ACA/UA (p = .02), and PCA/UA (p = .003) were significantly lower in the SGA group compared to controls. UA, ACA, MCA, and PCA PI were higher in women undergoing IOL for oligohydramnios compared to controls. Logistic regression analysis showed that CPR and PCA/UA ratio were independently associated with SGA. SGA, ACA PI, and ACA/UA were independently associated with CS for NRFS. Finally, birthweight centile, were independently associated with IOL oligohydramnios. Despite this, the predictive accuracy of Doppler in detecting any of the explored outcome was only poor to moderate. Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor. However, the predictive accuracy of Doppler at term is only poor to moderate, thus advising against its use in clinical practice as a standalone screening test for adverse perinatal outcome in pregnancies at term. Key Message Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor.

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