Am J Perinatol 2019; 36(02): 155-160
DOI: 10.1055/s-0038-1661404
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Normogram of Middle Cerebral Artery Doppler Indexes and Cerebroplacental Ratio at 12 to 14 Weeks in an Unselected Pregnancy Population

Reem S. Abu-Rustum
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
M. Fouad Ziade
2  Faculty of Public Health, Lebanese University, Tripoli, Lebanon
Ibrahim Ghosn
3  Department of Radiology, Lebanese University, Beirut, Lebanon
Nabil Helou
4  Department of Radiology, Aboujaoude Hospital, Jal El Dib, Lebanon
› Author Affiliations
Further Information

Publication History

07 November 2017

21 May 2018

Publication Date:
06 July 2018 (online)


Objective The aim of this study is to assess the feasibility of visualizing the middle cerebral artery (MCA), establishing the normogram for MCA pulsatility index (PI) and peak systolic velocity (PSV), and calculating cerebroplacental ratio (CPR) at 12 to 14 weeks.

Study Design Prospective cross-sectional study on 186 gravidas presenting for nuchal translucency (NT) assessment. Maternal body mass index (BMI), fetal crown-rump length (CRL), biparietal diameter (BPD), and NT were obtained. Color Doppler was utilized to visualize the MCA and measure PI, PSV, and umbilical artery PI. Normograms for MCA PI and PSV, and for CPR, were constructed. Regression analysis was used for the reference range of MCA PI and CPR according to CRL and BPD. Chi-square and t-test were utilized. p-Value of < 0.05 was considered significant.

Results MCA was successfully visualized in 176/186 (94.6%), PI and PSV measured on 148/186 (79.6%) and 145/186 (78.0%), respectively, and CPR calculated in 133/186 (71.5%). There was no significant effect of BMI, CRL, or BPD on successful assessment of MCA or CPR. Normograms for MCA PI and CPR revealed no significant relation with CRL or BPD.

Conclusion MCA and CPR assessment is feasible at 12 to 14 weeks. A reference range for MCA Doppler indexes and CPR at 12 to 14 weeks has been established. This may prove helpful in the early evaluation of fetuses identified as at-risk for adverse neonatal outcome.


This article has been presented as two oral abstract presentations at the AIUM Annual Convention in Orlando, Florida, in March 2017.