Professional paper
MIDDLE CEREBRAL ARTERY FLOW VELOCITY WAVEFORMS IN PREDICTION OF ADVERSE OUTCOMEIN INTRAUTERINE GROWTH RETARDED FETUSES
Mitko J. Ivanovski
Slobodan Lazarevski
Mihailo Popovic
Abstract
The development of a Doppler ultrasound technique offers new opportunities in the follow-up of the mater-nal and fetal circulation in the normal and in the high-risk pregnancies. Analysis of sonograms (Doppler velocity wave-form) on the a.cerebri media (ACM) gives important information about the status and the condition of the fetus. The resistance index (RI) has a significant application in the clinical practice for the detection and follow-up of the fetal growth and the perinatal outcome at the IUGR fetus. Material and methods. The Doppler ultrasound (US) follow-up was perfor-med in 86 normal pregnancies and 78 pregnancies with an IUGR of the fetus within the third trimester, divided in seven groups of gestational weeks (g.w.) With the Doppler machine TOSHIBA SONOLAYER SSA 120A and the application of an 3.75 MHz transabdominal probe, RI was determined at the a.cerebri media ( RIACM). Results. The analysis of the RIACM in normal pregnancies showed that the distribution was regular in the followed-up gestational weeks which manifested as a permanent decrease of the values for RIACM (of 0.83 in the 28–29 g.w.; 0.77 in the 34 –35 g.w., up to 0.725 at the term). In the pregnancies with an IUGR of the fetus, the RIACM was measured, which for any group of a g.w. statistically was significantly different from the findings in the normal pregnancies (p<0.05). Abnormal Doppler findings had a strong association with Apgar score 5min<7 ; SC-FD; NICU >48 h (p<0.001). In the prediction of the generally bad perinatal outcome, which includes all the previously analyzed parameters, RIACM predicted bad perinatal outcome with sensitivity (68.9%), specificity (77%), PPV (79%) and NPV (69.4%). Conclusion. The RIACM represents an important Doppler parameter for prediction of perinatal outcome in the clinical practice. Apart from the numerous results which promote Doppler ultrasound as the earliest predictor of the fetal suffering than the CTG, the best results could be obtained by application of these two and several other antepartal methods and analyses. Doppler US analysis points out to chronic changes which do not mean that the pregnancy has to be terminated at once until acute changes are detected by CTG. These two methods do not exclude each other, but on the contrary they complement each other.
Keywords
perinatal outcome; IUGR; a. cerebri media flow
Hrčak ID:
15791
URI
Publication date:
30.9.2005.
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