title: Prognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction.
abstract: OBJECTIVE
  To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR).
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Third-level Perinatology Center in Northern Italy.
  
  
  METHODS
  A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements.
  
  
  METHODS
  FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage.
  
  
  METHODS
  Perinatal death and neonatal brain damage.
  
  
  RESULTS
  The prevalence of fetal/neonatal death or brain damage was 18.2% (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2% (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95% confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95% CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95% CI=0.02-6.13, Synergy index=27.7, p=0.007).
  
  
  CONCLUSIONS
  In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.
authors.affiliation: Department of Obstetrics and Gynecology IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy. spinillo@smatteo.pv.it
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.forename: Laura
authors.initials: L
authors.lastname: Montanari
authors.forename: Marianna
authors.initials: M
authors.lastname: Roccio
authors.forename: Silvia
authors.initials: S
authors.lastname: Zanchi
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Tzialla
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging*; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D011379:Prognosis; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*