Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)

Abdelhassib Salah Abdelhassib Saad; Medhat Esam Eldeen Helmy; Ahmed Nabil Abdelhameed Eissa; Mohamed Momtaz Mohamed Awad; Hassan Mostafa Ismael Gahfar; Wael Gaber Elsyed El Damaty

doi:doi:10.11648/j.ajhr.20140205.11

Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)

Abdelhassib Salah Abdelhassib Saad, Medhat Esam Eldeen Helmy, Ahmed Nabil Abdelhameed Eissa, Mohamed Momtaz Mohamed Awad, Hassan Mostafa Ismael Gahfar, Wael Gaber Elsyed El Damaty

Published in American Journal of Health Research (Volume 2, Issue 5)

Received: 6 August 2014 Accepted: 23 August 2014 Published: 10 September 2014

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Abstract

Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation) to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.

Published in	American Journal of Health Research (Volume 2, Issue 5)
DOI	10.11648/j.ajhr.20140205.11
Page(s)	222-228
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Doppler Ultrasonograph, Umbilical Artery Doppler, Middle Cerebral Artery Doppler, Cerebro Placental Ratio, Late Onset Small for Gestational Age

References

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[2]	Royal college of obstetrics and gynaecology (RCOG). Green-top guidelines. The investigation and management of the small-forgestational-age fetus. RCOG Press: London, 2002.
[3]	Figueras F, Eixarch E, Meler E, Iraola A, Figueras J, Puerto B, Gratacos E. Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome. Eur J Obstet Gynecol Reprod Biol 2008; 136: 34–38.
[4]	Savchev S, Figueras F, Cruz-Martinez R, Illa M, Botet F, Gratacos E: Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound Obstet Gynecol 2012; 39: 299–303
[5]	Pisaneschi S, Francesca A. L. Strigini, Angel M. Sanchez, Silvia Begliuomini, and et al. Compensatory Feto-Placental Upregulation of the Nitric Oxide System during Fetal Growth Restriction. PLoS One. 2012; 7(9): e45294.
[6]	RCOG: Royal College of Obstetricians and Gynaecologists green-top guidelines (UK): the investigation and management of the small for- gestational-age fetus. http//:rcog.org.uk/files/rcogcorp/uploaded-iles/GT31SmallGestationalAgeFetus.pdf,2009.
[7]	Oros D, Figueras F, Cruz-Marteinz R, Meler E, M. Munmany M and Gratacos E: Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses, Ultrasound Obstet Gynecol 2011; 37: 191–195.
[8]	RCOG: Royal College of Obstetricians and Gynaecologists green-top guidelines (UK): The investigation and management of the small for-gestational-age fetus. http//:rcog.org.uk/files/rcogcorp/Uploaded-files/GT31 SmallGestationalAgeFetus.pdf. (Green-top No31) 2nd Edition \| February 2013, Minor revisions – January 2014
[9]	Ursula F. Harkness, MD, MPH, Giancarlo Mari, MD. Diagnosis and management of intrauterine growth restriction. Clin Perinatol 2004; 31:743– 764
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[11]	Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Oros D,Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011; 117: 618–626.
[12]	Arbeille P, Carles G, Chevillot M, Herve P, Perrotin F and Maulik D. Cerebral and umbilical Doppler in the prediction of fetal outcome. In: Maulik D and Zalud I (eds). Doppler ultrasound in obstetrics and gynecology.2005; 2nd ed. Springer-Verlag Berlin Heidelberg New York; 177-198.
[13]	Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A.Cerebral–umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79: 416–420.
[14]	Arduini D, Rizzo G, Boccolini MR, Romanini C, Mancuso S. Functional assessment of uteroplacental and fetal circulations by means of color Doppler ultrasonography. J Ultrasound Med 1992; 9: 249–53
[15]	Turan OM, Turan S, Gungor S, Berg C, Moyano D, GembruchU, Nicolaides KH, Harman CR, Baschat AA. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 32: 160–167.

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Abdelhassib Salah Abdelhassib Saad, Medhat Esam Eldeen Helmy, Ahmed Nabil Abdelhameed Eissa, Mohamed Momtaz Mohamed Awad, Hassan Mostafa Ismael Gahfar, et al. (2014). Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). American Journal of Health Research, 2(5), 222-228. https://doi.org/10.11648/j.ajhr.20140205.11

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ACS Style

Abdelhassib Salah Abdelhassib Saad; Medhat Esam Eldeen Helmy; Ahmed Nabil Abdelhameed Eissa; Mohamed Momtaz Mohamed Awad; Hassan Mostafa Ismael Gahfar, et al. Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). Am. J. Health Res. 2014, 2(5), 222-228. doi: 10.11648/j.ajhr.20140205.11

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AMA Style

Abdelhassib Salah Abdelhassib Saad, Medhat Esam Eldeen Helmy, Ahmed Nabil Abdelhameed Eissa, Mohamed Momtaz Mohamed Awad, Hassan Mostafa Ismael Gahfar, et al. Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). Am J Health Res. 2014;2(5):222-228. doi: 10.11648/j.ajhr.20140205.11

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@article{10.11648/j.ajhr.20140205.11,
  author = {Abdelhassib Salah Abdelhassib Saad and Medhat Esam Eldeen Helmy and Ahmed Nabil Abdelhameed Eissa and Mohamed Momtaz Mohamed Awad and Hassan Mostafa Ismael Gahfar and Wael Gaber Elsyed El Damaty},
  title = {Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)},
  journal = {American Journal of Health Research},
  volume = {2},
  number = {5},
  pages = {222-228},
  doi = {10.11648/j.ajhr.20140205.11},
  url = {https://doi.org/10.11648/j.ajhr.20140205.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20140205.11},
  abstract = {Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes  in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation)  to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.},
 year = {2014}
}

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TY  - JOUR
T1  - Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)
AU  - Abdelhassib Salah Abdelhassib Saad
AU  - Medhat Esam Eldeen Helmy
AU  - Ahmed Nabil Abdelhameed Eissa
AU  - Mohamed Momtaz Mohamed Awad
AU  - Hassan Mostafa Ismael Gahfar
AU  - Wael Gaber Elsyed El Damaty
Y1  - 2014/09/10
PY  - 2014
N1  - https://doi.org/10.11648/j.ajhr.20140205.11
DO  - 10.11648/j.ajhr.20140205.11
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 222
EP  - 228
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20140205.11
AB  - Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes  in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation)  to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.
VL  - 2
IS  - 5
ER  -

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Author Information

Abdelhassib Salah Abdelhassib Saad

Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, sheben el kom, Egypt
Medhat Esam Eldeen Helmy

Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, sheben el kom, Egypt
Ahmed Nabil Abdelhameed Eissa

Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, sheben el kom, Egypt
Mohamed Momtaz Mohamed Awad

Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Hassan Mostafa Ismael Gahfar

Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Wael Gaber Elsyed El Damaty

Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, sheben el kom, Egypt

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APA Style

Abdelhassib Salah Abdelhassib Saad, Medhat Esam Eldeen Helmy, Ahmed Nabil Abdelhameed Eissa, Mohamed Momtaz Mohamed Awad, Hassan Mostafa Ismael Gahfar, et al. (2014). Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). American Journal of Health Research, 2(5), 222-228. https://doi.org/10.11648/j.ajhr.20140205.11

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ACS Style

Abdelhassib Salah Abdelhassib Saad; Medhat Esam Eldeen Helmy; Ahmed Nabil Abdelhameed Eissa; Mohamed Momtaz Mohamed Awad; Hassan Mostafa Ismael Gahfar, et al. Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). Am. J. Health Res. 2014, 2(5), 222-228. doi: 10.11648/j.ajhr.20140205.11

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AMA Style

Abdelhassib Salah Abdelhassib Saad, Medhat Esam Eldeen Helmy, Ahmed Nabil Abdelhameed Eissa, Mohamed Momtaz Mohamed Awad, Hassan Mostafa Ismael Gahfar, et al. Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses). Am J Health Res. 2014;2(5):222-228. doi: 10.11648/j.ajhr.20140205.11

Copy | Download

@article{10.11648/j.ajhr.20140205.11,
  author = {Abdelhassib Salah Abdelhassib Saad and Medhat Esam Eldeen Helmy and Ahmed Nabil Abdelhameed Eissa and Mohamed Momtaz Mohamed Awad and Hassan Mostafa Ismael Gahfar and Wael Gaber Elsyed El Damaty},
  title = {Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)},
  journal = {American Journal of Health Research},
  volume = {2},
  number = {5},
  pages = {222-228},
  doi = {10.11648/j.ajhr.20140205.11},
  url = {https://doi.org/10.11648/j.ajhr.20140205.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20140205.11},
  abstract = {Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes  in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation)  to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.},
 year = {2014}
}

Copy | Download

TY  - JOUR
T1  - Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)
AU  - Abdelhassib Salah Abdelhassib Saad
AU  - Medhat Esam Eldeen Helmy
AU  - Ahmed Nabil Abdelhameed Eissa
AU  - Mohamed Momtaz Mohamed Awad
AU  - Hassan Mostafa Ismael Gahfar
AU  - Wael Gaber Elsyed El Damaty
Y1  - 2014/09/10
PY  - 2014
N1  - https://doi.org/10.11648/j.ajhr.20140205.11
DO  - 10.11648/j.ajhr.20140205.11
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 222
EP  - 228
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20140205.11
AB  - Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes  in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation)  to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.
VL  - 2
IS  - 5
ER  -

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