[Brain-sparing effect: comparison of diagnostic indices].
OBJECTIVE
to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes.


METHODS
151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's chi2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend.


RESULTS
the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA), 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, and anemia. There has been no significant difference between the two indexes of adverse perinatal outcome.
Franzin
Cleide Mara Mazzotti de Oliveira
CM
Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil. cleide.franzin@gmail.com
e Silva
João Luiz Pinto
JL
Pereira
Belmiro Gonçalves
BG
Marba
Sérgio Tadeu Martins
ST
Morais
Sirlei Siceni
SS
Amaral
Tatiana
T
Reszka
Erick Barbosa
EB
D001921:Brain / Q000098:blood supply* / Q000196:embryology*; D002560:Cerebrovascular Circulation; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011247:Pregnancy; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging