Evaluation of Doppler indices (MCA & UA) and fetal outcomes: a retrospective case-control study in women with hypertensive disorders of pregnancy

Abstract

Background

Hypertensive disorders of pregnancy (HDP) is associated with an increased risk of adverse outcomes. The fetal middle cerebral artery (MCA) and umbilical artery (UA) blood flow detected by ultrasound are recommended to evaluate the oxygenation of the fetus. It is necessary to analyze the relationship between MCA & UA doppler indices or cerebroplacental ratio (CPR) and fetal outcomes and describe MCA and UA blood flow values across gestation.

Methods

Hospital-based retrospective case-control study during 2016 to 2020. 800 singleton pregnant women: 400 normotensive control, 219 gestational hypertension (GH), and 181 preeclampsia (PE)/eclampsia (EC). An analysis of the outcomes of mothers and neonates was performed. The fetal MCA and UA blood flow values across gestation were established, and MCA-resistance index (RI) and CPR were used to predict fetal distress and small for gestational age (SGA).

Results

In the normotensive control, GH and PE/EC groups, the mean gestational age (GA) was 38.9 ± 1.2 weeks, 39.0 ± 1.0 weeks, and 38.6 ± 1.3 weeks respectively, and the mean birth weight (BW) was 3.195 ± 0.387 kilograms, 3.198 ± 0.428 kilograms, and 2.987 ± 0.544 kilograms respectively. There were differences in GA, BW, fetal distress, SGA and intraventricular hemorrhage I-II between the hypertension group and normotensive control group (p < 0.05). The MCA-RI (sensitivity: 70.1%, specificity: 64.3%) and MCA-RI (sensitivity: 52.4%, specificity: 84.6%) were the best indices to predict fetal distress and SGA, respectively during GA of 35-40 weeks.

Conclusions

Fetal MCA blood flow values and CPR are of great benefit for obstetricians to evaluate the status of fetus evidentially in singleton pregnancy.

Keywords:

• Hypertensive disorders of pregnancy
• fetal middle cerebral artery
• fetal umbilical artery
• fetal distress
• small for gestational age
• cerebroplacental ratio

Acknowledgments

The authors want to thank the hospitals of Fujian Maternity and Child Health Hospital (the department of neonatology, electrophysiology, and ultrasonic diagnosis Department) for their permission and the nurses and medical officers who were hard working during the study for their support. This study was carried out without grant. The name of “The School of Medical Technology and Engineering” was changed to “The School of Medical Imaging” to fit with the development of school in 2023. Thus, the unit of Li-Juan Zheng has to be changed into “The School of Medical Imaging, Fujian Medical University, Fujian Province, P.R. China”.

Ethics approval and consent to participate

The study was approved by the ethics committee of Fujian Maternity and Child Health Hospital (Ethics approval number: 2020KY065). Informed written and verbal consent was obtained from the infants’ parents or guardians. The trial was performed in accordance with the approved guidelines and regulations of the participating institutions.

Author contributions

X, L proposed the idea of this work, analyzed the data, prepared tables, and Figures 1 and 2, and wrote the main manuscript text. L-l, L collected the clinical data and took part in the analysis of data. L-j, Z collected the clinical data and prepared Figure 1. C-y, Y amended the manuscript text. All authors reviewed the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.