title: Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries.
abstract: OBJECTIVE
  To determine and compare the diagnostic performance of fetal middle cerebral (MCA), renal (RA), and umbilical (UA) arterial Doppler ultrasonography (US) for prediction of adverse perinatal outcome in suspected intrauterine growth restriction (IUGR).
  
  
  METHODS
  Two hundred ninety-three small-for-gestational age fetuses (24-39 weeks at recruitment and US-estimated weight or abdominal circumference below 10th percentile) were prospectively examined with Doppler US of the UA, MCA, and RA. Clinicians were blinded to MCA and RA Doppler measurements.
  
  
  RESULTS
  Seventy-six fetuses (25.9%) had at least one major or minor adverse perinatal outcome. Major outcomes included stillbirth, neonatal death, neurologic complication, and necrotizing enterocolitis. The MCA pulsatility index (PI), compared with the UA PI and RA PI, was more sensitive (72.4% vs 44.7% and 8.3%) but less specific (58.1% vs 86.6% and 92.6%) in predicting adverse outcome. The UA PI had the highest positive likelihood ratio (ratio, 3.3); the MCA PI had the lowest negative likelihood ratio (ratio, 0.48). When gestational age at the first Doppler US examination was less than 32 weeks, the MCA PI had a sensitivity of 95.5% and negative predictive value of 97.7% for major adverse outcome (negative likelihood ratio, 0.10).
  
  
  CONCLUSIONS
  In suspected IUGR, while an abnormal UA PI is a better predictor of adverse perinatal outcome than an abnormal MCA or RA PI, a normal MCA PI may help to identify fetuses without major adverse perinatal outcome, especially before 32 weeks gestational age.
authors.affiliation: Dept of Medical Imaging, Sunnybrook and Women's College Health Sciences Center, Toronto, Canada. katherine.fong@swchsc.on.ca
authors.forename: K W
authors.initials: KW
authors.lastname: Fong
authors.forename: A
authors.initials: A
authors.lastname: Ohlsson
authors.forename: M E
authors.initials: ME
authors.lastname: Hannah
authors.forename: S
authors.initials: S
authors.lastname: Grisaru
authors.forename: J
authors.initials: J
authors.lastname: Kingdom
authors.forename: H
authors.initials: H
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.forename: R
authors.initials: R
authors.lastname: Windrim
authors.forename: G
authors.initials: G
authors.lastname: Foster
authors.forename: K
authors.initials: K
authors.lastname: Amankwah
mesh_terms: D001921:Brain / Q000098:blood supply / Q000196:embryology; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005333:Fetus / Q000098:blood supply*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000098:blood supply / Q000196:embryology; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D011859:Radiography; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging