Middle cerebral artery peak systolic velocity

a new Doppler parameter in the assessment of growth-restricted fetuses

MARI, G.
HANIF, F.
KRUGER, M.
COSMI, E.
SANTOLAYA-FORGAS, J.
TREADWELL, M. C.

^*Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
†Department of Obstetrics and Gynecology, University of Padova, Padova, Italy
‡Department of Obstetrics and Gynecology, Harvard University, Boston, MA, USA

Correspondence to: Dr G. Mari, Department of Obstetrics and Gynecology, Wayne State University, John R (Hutzel Hospital—7 Brush), Detroit, MI 48201, USA (e-mail: [email protected]

Accepted: 8 December 2006

Ultrasound in Obstetrics & Gynecology 29(3):p 310-316, March 2007.

Objective

The aims of this study were to determine if there is a relationship between middle cerebral artery (MCA) peak systolic velocity (PSV) and perinatal mortality in preterm intrauterine growth-restricted (IUGR) fetuses, to compare the performance of MCA pulsatility index (PI), MCA-PSV and umbilical artery (UA) absent/reversed end-diastolic velocity (ARED) in predicting perinatal mortality, to determine the longitudinal changes that occur in MCA-PI and MCA-PSV in these fetuses, and to test the hypothesis that MCA-PSV can provide additional information on the prognosis of hypoxemic IUGR fetuses.

Methods

This was a retrospective cross-sectional study of 30 IUGR fetuses (estimated fetal weight < 3^rd percentile; UA-PI > 95% CI) in which the last MCA-PI, MCA-PSV and UA values were obtained within 8 days before delivery or fetal demise. Among the 30 fetuses, there were 10 in which at least three consecutive measurements were performed before delivery and these were used for a longitudinal study. MCA-PSV and MCA-PI values were plotted against normal reference ranges and were considered abnormal when they were above the MCA-PSV or below the MCA-PI reference ranges.

Results

Gestational age at delivery ranged between 23 + 1 and 32 + 5 (median, 27 + 6) gestational weeks. Birth weight ranged from 282 to 1440 (median, 540) g. There were 11 perinatal deaths. Forward stepwise logistic regression indicated that MCA-PSV was the best parameter in the prediction of perinatal mortality (odds ratio, 14; 95% CI, 1.4–130; P < 0.05) (Nagerlke R² = 31). In the 10 fetuses studied longitudinally, an abnormal MCA-PI preceded the appearance of an abnormal MCA-PSV. In these fetuses, the MCA-PSV consistently showed an initial increase in velocity; before demise or the appearance of a non-reassuring test in seven fetuses, there was a decrease in blood velocity. The MCA-PI presented an inconsistent pattern.

Conclusions

In IUGR fetuses, the trends of the MCA-PI and MCA-PSV provide more clinical information than does one single measurement. A high MCA-PSV predicts perinatal mortality better than does a low MCA-PI. We propose that MCA-PSV might be valuable in the clinical assessment of IUGR fetuses that have abnormal UA Doppler. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.