Fetal Brain Doppler to Predict Cesarean Delivery for Nonreassuring Fetal Status in Term Small-for-Gestational-Age Fetuses

Cruz-Martínez, Rogelio MD; Figueras, Francesc MD, PhD; Hernandez-Andrade, Edgar MD, PhD; Oros, Daniel MD; Gratacos, Eduard MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31820b0884
Original Research
Abstract

OBJECTIVE: To estimate the value of fetal brain Doppler in predicting the risk of cesarean delivery for nonreassuring fetal status and neonatal acidosis after labor induction in small-for-gestational-age fetuses with normal umbilical artery Doppler.

METHODS: Fetal brain Doppler parameters, including cerebral tissue perfusion measured by fractional moving blood volume, cerebroplacental ratio, and middle cerebral artery pulsatility index, were evaluated before labor induction in a cohort of 210 term small-for-gestational-age fetuses with normal umbilical artery Doppler and 210 control participants matched by gestational age. The value of the cerebral Doppler indices to predict the risk of cesarean delivery, cesarean delivery for nonreassuring fetal status, and neonatal acidosis was analyzed.

RESULTS: Overall, small-for-gestational-age fetuses showed a significant higher incidence of cesarean delivery (37.6% compared with 19.5%, P<.001), cesarean delivery for nonreassuring fetal status (29% compared with 4.8%, P<.001), and neonatal acidosis (7.6% compared with 2.4%, P=.03) than control participants. Within the small-for-gestational-age group, middle cerebral artery vasodilation was associated with the highest risk of cesarean delivery (67.7% compared with 32.4%, P<.001) and cesarean delivery for nonreassuring fetal status (58.1% compared with 24%, P<.001). In the subgroup of normal middle cerebral artery, incorporation of cerebroplacental ratio further distinguished two groups with different risks of cesarean delivery (51.4% compared with 27.5%, P<.01) and cesarean delivery for nonreassuring fetal status (37.8% compared with 20.4%, P=.01). Middle cerebral artery vasodilation was associated with increased risk of neonatal acidosis (odds ratio, 9.0). Fractional moving blood volume was not associated with the risk of cesarean delivery for nonreassuring fetal status or neonatal acidosis.

CONCLUSION: Evaluation of brain Doppler indices before labor induction discriminates small-for-gestational-age fetuses at high risk of cesarean delivery for nonreassuring fetal status and neonatal acidosis.

LEVEL OF EVIDENCE: II

In Brief

Evaluation of fetal brain Doppler allows identification of term small-for-gestational-age fetuses with the highest risk of emergency cesarean delivery for nonreassuring fetal status.

Author Information

From the Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and the Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

Supported by grants from the Fondo de Investigación Sanitaria (PI/060347) (Spain), Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK), and Thrasher Research Fund (Salt Lake City, UT). R.C. was supported by Marie Curie Host Fellowships for Early Stage Researchers, FETAL-MED-019707-2 and by the Mexican National Council for Science and Technology (CONACyT). E.H.-A. was supported by a Juan de la Cierva postdoctoral fellowship, Fondo de Investigaciones Sanitarias, Spain.

Presented at the 9th World Congress in Fetal Medicine and the Eurofoetus Meeting, Fetal Medicine Foundation of London, June 20–24, 2010, Rhodes, Greece; and at the 20th World Congress on Ultrasound in Obstetrics and Gynecology (ISUOG), October 10–14, 2010, Prague, Czech Republic.

Corresponding author: Eduard Gratacos, PhD, Maternal-Fetal Medicine Department, Hospital Clinic, University of Barcelona, Sabino de Arana 1, 08028 Barcelona, Spain; e-mail: gratacos@clinic.ub.es.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists