Middle versus anterior cerebral artery Doppler for the prediction of perinatal outcome and neonatal neurobehavior in term small‐for‐gestational‐age fetuses with normal umbilical artery Doppler

• Published in: Ultrasound in obstetrics & gynecology Vol. 35; no. 4; pp. 456 - 461
• Main Authors: Oros, D., Figueras, F., Cruz‐Martinez, R., Padilla, N., Meler, E., Hernandez‐Andrade, E., Gratacos, E.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2010; Wiley
• Subjects: Adult; anterior cerebral artery; Anterior Cerebral Artery - diagnostic imaging; Anterior Cerebral Artery - physiology; Biological and medical sciences; Cardiovascular system; Cerebrovascular Circulation - physiology; Child Development - physiology; Developmental Disabilities - diagnostic imaging; Developmental Disabilities - physiopathology; Diseases of mother, fetus and pregnancy; Doppler; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Infant, Small for Gestational Age; intrauterine growth restriction; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; middle cerebral artery; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - physiology; perinatal outcome; Pregnancy; Pregnancy. Fetus. Placenta; Prospective Studies; Social Behavior; Ultrasonic investigative techniques; Ultrasonography, Doppler - methods; Ultrasonography, Prenatal - methods; Umbilical Arteries - diagnostic imaging; Sonography; Human; Doppler ultrasound study; Intrauterine growth retardation; Neonatal; Prognosis; Pregnancy disorders; Gynecology; Middle cerebral artery; Low birth weight; Perinatal; Umbilical artery; Anterior cerebral artery; Obstetrics; Fetal diseases; Newborn diseases; Newborn; Prematurity; intrauterine growth restriction; Fetus; Predictive factor; Comparative study; Doppler; perinatal outcome
• DOI: 10.1002/uog.7588
• ISSN: 0960-7692; 1469-0705

Objective To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small‐for‐gestational‐age (SGA) fetuses with normal umbilical artery (UA) Doppler. Methods MCA and ACA Doppler ultrasonography was performed in a cohort of SGA term fetuses with normal UA Doppler. Perinatal outcome and neonatal neurobehavioral performance were compared with a group of term appropriate‐for‐gestational age (AGA) infants. Neurobehavior was evaluated at 40 ( ± 1) weeks of corrected age with the Neonatal Behavioral Assessment Scale. Differences between the study groups were adjusted for potential confounding variables by multiple linear or logistic regression analyis. Results A total of 199 newborns (98 SGA and 101 AGA) were included. Among the SGA fetuses, 28.6 and 17% had MCA and ACA redistribution, respectively. Cases with either type of redistribution had an increased risk for adverse outcome, with no differences in predictive performance between the two parameters. SGA fetuses with MCA redistribution compared with controls had an increased risk for abnormal neurobehavioral performance in motor (36 vs. 20%; adjusted P = 0.02) and state organization (25 vs. 17.5%; adjusted P = 0.03) areas. SGA fetuses with ACA redistribution had only an increased risk for abnormal neurobehavioral performance area in state organization compared with controls (30 vs. 17.5%; adjusted P = 0.021). Conclusion In term SGA newborns with no signs of brain‐sparing, ACA Doppler investigation does not provide any benefit over MCA in terms of the prediction of adverse perinatal outcome. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.