title: Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.
abstract: BACKGROUND
  Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing.
  
  
  OBJECTIVE
  Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies).
  
  
  METHODS
  MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth.
  
  
  METHODS
  Cord blood gases were related to signs of centralization of fetal circulation in the MCA.
  
  
  RESULTS
  No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing.
  
  
  CONCLUSIONS
  Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital MAS, Malmö, Sweden.
authors.forename: Riffat
authors.initials: R
authors.lastname: Cheema
authors.forename: Mariusz
authors.initials: M
authors.lastname: Dubiel
authors.forename: Saemundur
authors.initials: S
authors.lastname: Gudmundsson
mesh_terms: D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005311:Fetal Hypoxia / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D020768:Middle Cerebral Artery / Q000503:physiopathology; D011247:Pregnancy; D018566:Pregnancy, High-Risk