CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(02): 118-124
DOI: 10.1055/s-0041-1741453
Original Article
High Risk Pregnancy

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

Análise da correlação/concordância dos parâmetros Doppler materno-fetal em fetos normais e com restrição do crescimento
1   Department of Gynecology and Obstetrics, Universidade Federal do Paraná, Curitiba, PR, Brazil
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1   Department of Gynecology and Obstetrics, Universidade Federal do Paraná, Curitiba, PR, Brazil
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1   Department of Gynecology and Obstetrics, Universidade Federal do Paraná, Curitiba, PR, Brazil
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1   Department of Gynecology and Obstetrics, Universidade Federal do Paraná, Curitiba, PR, Brazil
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1   Department of Gynecology and Obstetrics, Universidade Federal do Paraná, Curitiba, PR, Brazil
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2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
› Author Affiliations

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 ≤ 9th percentile (small for gestational age [SGA]), there was agreement between U/C > 1.0 and CPR < 5th 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 < 5o 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.

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

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