Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study

Abstract

Objective To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term.

Material and Methods Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10^th and 90^th percentile, at 36 + 0–37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data.

Results 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor.

Conclusion Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

Zusammenfassung

Ziel Aufklärung der Rolle des Dopplerultraschalls bei der Vorhersage des perinatalen Outcomes von reifgeborenen Föten (AGA = appropriate for gestational age).

Material und Methoden Prospektive Studie in einer speziellen Ultraschall- Forschungsklinik. Das Einschlusskriterium waren AGA-Föten, definiert durch ein geschätztes fetales Gewicht zwischen der 10. bis 90. Perzentile und der 36 + 0 bis 37 + 6 Schwangerschaftswoche. Der primäre Endpunkt war ein zusammengesetzter Score für das negative perinatale Outcome einschließlich unerwünschter intrapartaler Komplikationen oder einem abnormalen Säure-Basen-Status bei der Geburt. Den sekundären Endpunkt bildeten die Einzelparameter des primären Endpunkts. Die untersuchten Dopplerparameter waren der PI der A. umbilicalis (UA), der A. cerebri media (MCA) und der A. uterinae (UtA) und die zerebroplazentare Ratio (CPR). Die anwesenden Ärzte waren für die Dopplerbefunde blind. Zur Datenanalyse wurden logistische Regressions- und ROC-Kurvenanalysen verwendet.

Ergebnisse 553 AGA-Föten wurden eingeschlossen. Es gab keinen Unterschied zwischen den mittleren Werten für UA-PI (p = 0,486), MCA-PI (p = 0,621), CPR (p = 0,832) und UtA-PI (p = 0,611) bei Schwangerschaften mit und ohne kombinierter perinataler Morbidität. In Schwangerschaften mit unerwünschten intrapartalen Komplikationen war der mittlere MCA-PI niedriger als in der Kontrollgruppe (1,47 ± 0,4 vs. 1,61 ± 0,4; p = 0,0039), während es keinen Unterschied zwischen UA-PI (p = 0,758), CPR (p = 0,108) und UtA-PI (p = 0,177) gab. Schließlich zeigten sich in keinem der untersuchten Dopplerparameter Unterschiede zwischen AGA-Föten mit abnormalem Säure-Basen-Status bei Geburt und solche ohne. In der logistischen Regressionsanalyse waren UA-PI, MCA-PI, CPR, UtA-PI, EFW und AC-Perzentilen nicht unabhängig voneinander mit einem kombinierten negativen Outcome, intrapartalen Komplikationen oder einem abnormalen Säure-Basen-Status bei der Geburt assoziiert. Die diagnostische Leistung all dieser Dopplerparameter zur Vorhersage von kombinierten intrapartalen Komplikationen und eines abnormalen Säure-Basen-Status war schlecht.

Schlussfolgerung Bei AGA-Föten kurz vor Entbindung stehen zerebroplazentare und maternale Doppler nicht in Zusammenhang mit einem schlechten Schwangerschaftsoutcome bzw. sagen dieses voraus.

Key words

Doppler - pregnancy - CPR - neonatal outcome - non-SGA fetuses

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