title: Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency.
abstract: OBJECTIVE
  To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.
  
  
  METHODS
  This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34(th) week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95(th) percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio--BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.
  
  
  RESULTS
  Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p<0.001), with a higher median of UA PI (2.9 vs. 1.7, p<0.001) and UA PI z-score (10.4 vs. 4.9, p<0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p=0.012); lower BPR (0.4 vs. 0.7, p<0.001); higher PIV-DV (1.2 vs. 0.8, p<0.001) and DV z-score (3.6 vs. 0.6, p<0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR=0.45; 95% CI: 0.3 to 0.7; p<0.001) and UA PI z-score (OR=1.14, 95% CI: 1.0 to 1.3, p=0.046).
  
  
  CONCLUSIONS
  Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.
authors.affiliation: Medical School, Universidade de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil. roseli.nomura@hotmail.com
authors.forename: Roseli Mieko Yamamoto
authors.initials: RM
authors.lastname: Nomura
authors.forename: Juliana Ikeda
authors.initials: JI
authors.lastname: Niigaki
authors.forename: Flávia Thiemi
authors.initials: FT
authors.lastname: Horigome
authors.forename: Rossana Pulcineli Vieira
authors.initials: RP
authors.lastname: Francisco
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000704:Analysis of Variance; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D010927:Placental Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
keywords: Artéria cerebral média; Artérias umbilicais; Cordão umbilical; Doppler; Fetal hypoxia; Hipóxia fetal; Insuficiência placentária; Middle cerebral artery; Placental insufficiency; Ultrasonography; Ultrassonografia; Umbilical arteries; Umbilical cord