Ultrasound/Imaging
Poster Session 2
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
Dahlia Klein, N/A
Université de Montréal
Montreal, QC, Canada
Moreyell Kahlon, MD
McMaster University
Hamilton, ON, Canada
Swati Agrawal, MD, MSCR
Hamilton Health Sciences
Toronto, ON, Canada
Homero Flores Mendoza, MD
McMaster University
Hamilton, ON, Canada
Howard Berger, MD
University of Toronto
Thornhill, ON, Canada
Bryon DeFrance, MD
McMaster University
Hamilton, ON, Canada
Jon F. Barrett, MD, PhD
Chair
Sunnybrook Health Science, University of Toronto
Toronto, ON, Canada
Eran Ashwal, MD
Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
Doppler studies play a crucial role in evaluating fetuses with impaired fetal growth. We aimed to assess the clinical variability of various published Doppler reference ranges for umbilical artery (UA), middle cerebral artery (MCA) pulsatility index (PI), and cerebroplacental ratio (CPR) in pregnancies complicated by impaired fetal growth, and their association with adverse perinatal outcomes.
Study Design:
This case control study included all singleton pregnancies without known genetic/structural anomalies and EFW and/or AC < 10th centile (Hadlock( for gestational age (2017-2022). Only cases with concurrent sampling of UA-PI, MCA-PI and CPR within 14 days of birth were considered. Abnormal fetal doppler was defined using clinically relevant cut-offs for gestational age: UA-PI > 95th centile, MCA-PI < 5th centile, and CPR < 5th centile. The primary outcome was a composite of adverse neonatal outcomes, including any one of the following: antenatal fetal death, cesarean section for suspected fetal distress, 5-minute Apgar score < 7, arterial cord pH < 7.1, need for intubation, sepsis, necrotizing enterocolitis, and prolonged NICU admission ( > 7 days). Multivariable logistic regression analysis was performed.
Results:
The cohort included 947 patients, of whom 438 (46.3%) experienced adverse perinatal outcomes, while 509 (53.7%) had normal outcomes. The predictive performance for adverse perinatal outcomes of various published Doppler reference values showed variability. Sensitivity ranged from 58.5% to 67.4% for UA, 55.4% to 61.4% for MCA, and 52.1% to 58.8% for CPR. Corresponding specificities ranged from 56.0% to 60.0%, 58.0% to 60.7%, and 61.4% to 61.9%, respectively (Table). After multivariate analysis, which controlled for relevant covariates, a range of association between clinically relevant cut-offs and adverse perinatal outcomes was demonstrated, with MCA-PI and CPR showing stronger associations with adverse outcomes.
Conclusion:
Choosing a Doppler reference chart may result in significant variation in the clinical management of pregnancies complicated by impaired fetal growth.