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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)

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Abstract

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.

Keywords

middle cerebral artery - first trimester scan - pulsatility index - peak systolic velocity - cerebroplacental ratio

Note

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


 

  • References

  • 1 Abu-Rustum RS, Daou L, Abu-Rustum SE. Role of first-trimester sonography in the diagnosis of aneuploidy and structural fetal anomalies. J Ultrasound Med 2010; 29 (10) 1445-1452
    CrossrefPubMedGoogle Scholar
  • 2 Rossi AC, Prefumo F. Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies: a systematic review. Obstet Gynecol 2013; 122 (06) 1160-1167
    CrossrefPubMedGoogle Scholar
  • 3 Hyett JA, Perdu M, Sharland GK, Snijders RS, Nicolaides KH. Increased nuchal translucency at 10-14 weeks of gestation as a marker for major cardiac defects. Ultrasound Obstet Gynecol 1997; 10 (04) 242-246
    CrossrefPubMedGoogle Scholar
  • 4 Hyett J, Perdu M, Sharland G, Snijders R, Nicolaides KH. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10-14 weeks of gestation: population based cohort study. BMJ 1999; 318 (7176): 81-85
    PubMedGoogle Scholar
  • 5 Matias A, Huggon I, Areias JC, Montenegro N, Nicolaides KH. Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10-14 weeks. Ultrasound Obstet Gynecol 1999; 14 (05) 307-310
    CrossrefPubMedGoogle Scholar
  • 6 Timmerman E, Clur SA, Pajkrt E, Bilardo CM. First-trimester measurement of the ductus venosus pulsatility index and the prediction of congenital heart defects. Ultrasound Obstet Gynecol 2010; 36 (06) 668-675
    CrossrefPubMedGoogle Scholar
  • 7 Pereira S, Ganapathy R, Syngelaki A, Maiz N, Nicolaides KH. Contribution of fetal tricuspid regurgitation in first-trimester screening for major cardiac defects. Obstet Gynecol 2011; 117 (06) 1384-1391
    CrossrefPubMedGoogle Scholar
  • 8 Sotiriadis A, Papatheodorou S, Eleftheriades M, Makrydimas G. Nuchal translucency and major congenital heart defects in fetuses with normal karyotype: a meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (04) 383-389
    PubMedGoogle Scholar
  • 9 Sinkovskaya ES, Chaoui R, Karl K, Andreeva E, Zhuchenko L, Abuhamad AZ. Fetal cardiac axis and congenital heart defects in early gestation. Obstet Gynecol 2015; 125 (02) 453-460
    CrossrefPubMedGoogle Scholar
  • 10 Donofrio MT, Bremer YA, Schieken RM. , et al. Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect. Pediatr Cardiol 2003; 24 (05) 436-443
    CrossrefPubMedGoogle Scholar
  • 11 Abu-Rustum RS, Ziade MF, Abu-Rustum SE, Daou LS. Are there head volume alterations at 11–14 weeks in fetuses with congenital heart defects? A first trimester case series. AJP Rep 2016; 6 (02) e232-e238
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Wladimiroff JW, Tonge HM, Stewart PA. Doppler ultrasound assessment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol 1986; 93 (05) 471-475
    CrossrefPubMedGoogle Scholar
  • 13 Wladimiroff JW, Huisman TW, Stewart PA. Fetal and umbilical flow velocity waveforms between 10-16 weeks' gestation: a preliminary study. Obstet Gynecol 1991; 78 (5 Pt 1): 812-814
    PubMedGoogle Scholar
  • 14 van Splunder P, Huisman TW, DeRidder MA, Wladimiroff JW. Fetal venous arterial flow velocity waveforms between 8 and 20 weeks of gestation. Pediatr Res 1996; 40: 158-162
    CrossrefPubMedGoogle Scholar
  • 15 Ursem NTC, Struijk PC, Hop WCJ, Clark EB, Keller BB, Wladimiroff JW. Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at 10-20 weeks of gestation. Clin Sci (Lond) 1998; 95 (05) 539-545
    PubMedGoogle Scholar
  • 16 Matias A, Montenegro N, Areias JC, Leite LP. Haemodynamic evaluation of the first trimester fetus with special emphasis on venous return. Hum Reprod Update 2000; 6 (02) 177-189
    CrossrefPubMedGoogle Scholar
  • 17 Tongsong T, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K. Middle cerebral artery peak systolic velocity of healthy fetuses in the first half of pregnancy. J Ultrasound Med 2007; 26 (08) 1013-1017
    CrossrefPubMedGoogle Scholar
  • 18 Rujiwetpongstorn J, Phupong V. Doppler waveform indices of the middle cerebral artery of normal fetuses in the first half of pregnancy in the Thai population. Arch Gynecol Obstet 2007; 276 (04) 351-354
    CrossrefPubMedGoogle Scholar
  • 19 Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79 (03) 416-420
    CrossrefPubMedGoogle Scholar
  • 20 Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003; 21 (02) 124-127
    CrossrefPubMedGoogle Scholar
  • 21 Official Statement AIUM. As Low As Reasonably Achievable (ALARA) Principle. Approved 3/16/2008; Reapproved 4/2/2014. Available at: http://www.aium.org/officialStatements/39 . Accessed June 5, 2018
    PubMedGoogle Scholar
  • 22 Official Statement AIUM. Statement on the Safe Use of Doppler Ultrasound During 11–14 week scans (or earlier in pregnancy). Approved 4/18/2011; Revised 3/21/2016, 10/30/2016. Available at: http://www.aium.org/officialStatements/42 . Accessed June 5, 2018
    PubMedGoogle Scholar
  • 23 Salvesen K, Lees C, Abramowicz J, Brezinka C, Ter Haar G, Maršál K. ISUOG statement on the safe use of Doppler in the 11 to 13 +6-week fetal ultrasound examination. Ultrasound Obstet Gynecol 2011; 37: 628-628
    CrossrefPubMedGoogle Scholar
  • 24 Clerici G, Luzietti R, Cutuli A, Direnzo GC. Cerebral hemodynamics and fetal behavioral states. Ultrasound Obstet Gynecol 2002; 19 (04) 340-343
    CrossrefPubMedGoogle Scholar
  • 25 Hsieh YY, Chang CC, Tsai HD, Tsai CH. Longitudinal survey of blood flow at three different locations in the middle cerebral artery in normal fetuses. Ultrasound Obstet Gynecol 2001; 17 (02) 125-128
    CrossrefPubMedGoogle Scholar