Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler
Open accessAbstract
Objective: To assess the value of different admission tests in predicting the outcome of small‐for‐gestational age (SGA) fetuses with normal Doppler waveforms in the umbilical artery. Methods: Criteria for admission into this retrospective study included: singleton pregnancy with a birth weight <10th centile; absence of severe maternal complications; no evidence of fetal anomalies on the sonogram; normal umbilical artery Doppler; and availability of complete follow‐up. At the first antenatal sonogram classifying the fetus as SGA, Doppler analysis of the uterine and middle cerebral arteries was performed and amniotic fluid volume was assessed. Outcome variables included adverse perinatal outcome (perinatal death, severe morbidity) and emergency Cesarean section for fetal distress. Results: Two hundred and thirty‐one pregnancies were included in the study. The mean ± standard deriation birth weight and gestational age at delivery were 2222 ± 502 g and 37.3 ± 2.9 weeks, respectively. In 37 cases (16%), an emergency Cesarean section was performed. There was one intrauterine death and three fetuses delivered by emergency Cesarean section developed severe morbidity. Logistic regression demonstrated that abnormal velocimetry of the uterine arteries and fetal middle cerebral artery were independently correlated with the occurrence of Cesarean section. Conclusions: SGA fetuses with normal umbilical artery Doppler waveforms and abnormal uterine arteries and fetal middle cerebral artery waveforms have an increased risk of developing distress and being delivered by emergency Cesarean section. Particularly when both uterine and fetal cerebral waveforms are altered at the same time, the risk is exceedingly high (86%) and delivery as soon as fetal maturity is achieved seems advisable. On the other hand, when both vessels have normal waveforms, the chances of fetal distress are small (4%) and expectant management is the most reasonable choice. Copyright © 2002 ISUOG
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In late-onset fetal growth restriction, cardiovascular adaptation is typically limited to the cerebral circulation and is commonly associated with normal Doppler of the umbilical arteries.
“In contrast, cardiovascular adaptation of late-onset FGR is typically limited to the cerebral circulation and is commonly associated with normal Doppler of the umbilical arteries.57,60,61”
From Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction (2020) · cites this paper as [61]
The Introduction (page unavailable) describes cerebral blood-flow redistribution as a fetal response to mild hypoxemia, and the Discussion (page unavailable) examines abnormal middle cerebral artery Doppler in third-trimester small-for-gestational-age fetuses with normal umbilical artery Doppler. But normal umbilical Doppler was an inclusion criterion, so the study does not establish that it is common across late-onset growth restriction or that cardiovascular adaptation is typically limited to the cerebral circulation. (LLM, conf=0.86)
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- Authors
- Severi, F. M., Bocchi, C., Visentin, A., Falco, P., Cobellis, L., Florio, P., Zagonari, S., & Pilu, G.
- Affiliations
- University of Siena (IT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Corresponding author
- Pilu, G.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2002-03
- Volume
- 19
- Issue
- 3
- Pages
- 225-228
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2063324282
- Cited by
- 248
- References
- 9
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 16 · 2020: 9 · 2019: 8 · 2018: 24 · 2017: 17 · 2016: 16 · 2015: 18 · 2014: 14 · 2013: 11 · 2012: 12
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Keywords
- small-for-gestational-age fetuses, uterine artery Doppler, middle cerebral artery Doppler, umbilical artery Doppler, fetal distress, emergency cesarean section, perinatal outcome prediction, third trimester, amniotic fluid volume
- MeSH terms
- Female, Fetal Growth Retardation, Humans, Infant, Newborn, Infant, Small for Gestational Age, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Third, Probability, Reference Values, Retrospective Studies, ROC Curve, Sensitivity and Specificity, Umbilical Arteries, Confidence Intervals, Odds Ratio, Ultrasonography, Prenatal, Ultrasonography, Doppler
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