Analysis of the Correlation/Agreement of Maternal–fetal Doppler Parameters in Normal and Growth-Restricted Fetuses

Abstract

Objective To assess the degree of correlation/agreement of maternal–fetal Doppler parameters between normal and growth-restricted fetuses (fetal growth restriction [FGR]).

Methods The present observational and retrospective study included 274 singleton pregnancies. The following maternal–fetal Doppler parameters were assessed: uterine artery (UAt), umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), and umbilical–cerebral ratio (U/C). The assessment of FGR was based on the Figueiras and Gratacós[9] criteria. Spearman correlation coefficients were estimated to assess the correlation between resistance (RI) and pulsatility (PI) indices of Doppler parameters. The agreement between two Doppler parameters was assessed by the Kappa coefficient.

Results In total, 502 Doppler examinations were included, and FGR was observed in 19 out of 274 fetuses. A strong correlation was observed between RI and PI of UAt, UA, and MCA in all of the samples (p < 0.001). Of the 502 Doppler examinations, there was agreement between U/C and CPR percentiles for 480 (95.6%) and disagreement for 22 (4.4%), with Kappa coefficient of 0.26, thereby corresponding to weak agreement. Of the 68 cases with estimated fetal weight ≤ 9^th percentile (small for gestational age [SGA]), there was agreement between U/C > 1.0 and CPR < 5^th percentile in 61 (88.4%) and disagreement in 7 (5.8%) with Kappa coefficient of 0.49, thereby corresponding to moderate agreement.

Conclusion Strong correlation was observed among RI and PI UAt, UA, and MCA Doppler examinations in the present study; however, weak agreement was observed between U/C and CPR in the normal and FGR fetuses. In SGA, U/C and CPR demonstrated moderate agreement.

Resumo

Objetivo Avaliar o grau de correlação/concordância dos parâmetros Doppler materno-fetal entre fetos normais e com restrição do crescimento (restrição de crescimento fetal [RCF]).

Métodos O presente estudo observacional e retrospectivo incluiu 274 gestações únicas. Os seguintes parâmetros Doppler materno-fetal foram avaliados: artéria uterina (AUt), artéria umbilical (AU), artéria cerebral média (ACM), razão cérebro-placentária (RCP) e razão umbilical-cerebral (U/C). A avaliação da RCF baseou-se nos critérios de Figueiras e Gratacós.[9] Os coeficientes de correlação de Spearman foram estimados para avaliar a correlação entre os índices de resistência (IR) e pulsatilidade (IP) dos parâmetros Doppler. A concordância entre dois parâmetros do Doppler foi avaliada pelo coeficiente Kappa.

Resultados No total, 502 exames Doppler foram incluídos e RCF foi observado em 19 de 274 fetos. Observou-se forte correlação entre IR e IP da AUt, AU e ACM em todas as amostras (p < 0,001). Dos 502 exames Doppler, houve concordância entre os percentis U/C e RCP para 480 (95,6%) e discordância para 22 (4,4%), com coeficiente Kappa de 0,26, correspondendo a concordância fraca. Dos 68 casos com peso fetal estimado ≤ 9° (pequeno para a idade gestacional [PIG]), houve concordância entre U/C > 1,0 e RCp < 5^o percentil em 61 (88,4%) e discordância em 7 (5,8%) com coeficiente Kappa de 0,49, correspondendo a concordância moderada.

Conclusão Forte correlação foi observada entre o IR e IP dos exames Doppler AUt, AU e ACM no presente estudo; entretanto, fraca concordância foi observada entre U/C e RCP em fetos normais e com RCF. Nos PIG, U/C e RCP demonstraram concordância moderada.

Keywords

fetal growth restriction - doppler - cerebroplacental ratio - agreement - correlation

Palavras-chave

restrição do crescimento fetal - doppler - relação cérebro-placentária - concordância - correlação

Contributions

All authors contributed to the design of the study, were involved in the data collection, data analysis and/or interpretation. Also, all authors contributed to the writing/substantive editing and review of the manuscript and approved the final draft of the manuscript.

Publication History

Received: 14 November 2020

Accepted: 05 October 2021

Article published online:
25 February 2022

• References

• 1 Nardozza LM, Caetano AC, Zamarian AC, Mazzola JB, Silva CP, Marçal VMG. et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet 2017; 295 (05) 1061-1077 DOI: 10.1007/s00404-017-4341-9.
• 2 Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol 2011; 204 (04) 288-300 DOI: 10.1016/j.ajog.2010.08.055.
• 3 Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963; 32: 793-800
• 4 Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018; 218 (2S, Suppl): S790-802.e1 DOI: 10.1016/j.ajog.2017.12.003.
• 5 Berkley E, Chauhan SP, Abuhamad A. Society for Maternal-Fetal Medicine Publications Committee. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol 2012; 206 (04) 300-308 DOI: 10.1016/j.ajog.2012.01.022.
• 6 Flood K, Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe F. et al. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study. Am J Obstet Gynecol 2014; 211 (03) 288.e1-288.e5 DOI: 10.1016/j.ajog.2014.05.008.
• 7 Dall'Asta A, Ghi T, Frusca T. Doppler diagnosis. In: Nardozza LM, Araujo Júnior E, Rizzo G, Deter RL. eds. Fetal growth restriction: current evidence and clinical practice. Cham: Springer; 2018: 139-170
• 8 Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O'Donogue K. et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013; 208 (04) 290.e1-290.e6 DOI: 10.1016/j.ajog.2013.02.007.
• 9 Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014; 36 (02) 86-98 DOI: 10.1159/000357592.
• 10 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 1985; 151 (03) 333-337 DOI: 10.1016/0002-9378(85)90298-4.
• 11 To WW, Chan AM, Mok KM. Use of umbilical-cerebral Doppler ratios in predicting fetal growth restriction in near-term fetuses. Aust N Z J Obstet Gynaecol 2005; 45 (02) 130-136 DOI: 10.1111/j.1479-828X.2005.00361.x.
• 12 Figueras F, Gratacos E, Rial M, Gull I, Krofta L, Lubusky M. et al. Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol. BMJ Open 2017; 7 (06) e014835 DOI: 10.1136/bmjopen-2016-014835.
• 13 Khanduri S, Parashari UC, Bashir S, Bhadury S, Bansal A. Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for detection of intrauterine growth restriction. J Obstet Gynaecol India 2013; 63 (04) 249-255 DOI: 10.1007/s13224-012-0326-6.
• 14 Rani S, Huria A, Kaur R. Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices. Hypertens Pregnancy 2016; 35 (02) 210-216 DOI: 10.3109/10641955.2015.1137585.
• 15 Cnossen JS, Morris RK, ter Riet G, Mol BWJ, van de Post JAM, Coomarasamy A. et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008; 178 (06) 701-711 DOI: 10.1503/cmaj.070430.
• 16 Triunfo S, Crispi F, Gratacos E, Figueras F. Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks' gestation. Ultrasound Obstet Gynecol 2017; 49 (03) 364-371 DOI: 10.1002/uog.15979.
• 17 Morales-Roselló J, Buongiorno S, Loscalzo G, Abad García C, Cañada Martínez AJ, Perales Marín A. Does uterine Doppler add information to the cerebroplacental ratio for the prediction of adverse perinatal outcome at the end of pregnancy?. Fetal Diagn Ther 2020; 47 (01) 34-44 DOI: 10.1159/000499483.
• 18 Lees CC, Stampalija T, Baschat A, da Silva Costa F, Ferrazzi E, Figueras F. et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56 (02) 298-312 DOI: 10.1002/uog.22134.