Cerebral and cardiac Doppler parameters in the identification of fetuses with late-onset intrauterine growth restriction at risk of adverse perinatal and neurobehavioral outcome

Abstract

[eng] Evaluation of fetal brain and cardiac Doppler parameters improves the identification of term, SGA fetuses with normal UA Doppler at risk of adverse perinatal outcome and abnormal neurobehavioral performance. SPECIFIC HYPOTHESIS: 1. Cerebral blood perfusion is increased in SGA fetuses with normal umbilical artery Doppler as compared with normally grown fetuses. 2. Increased cerebral blood perfusion is earlier detected by means of the fractional moving blood volume using power Doppler ultrasound than by spectral Doppler indices. 3. Incorporation of fetal cardiac Doppler parameters might improve the identification of SGA fetuses with late-onset growth restriction. 4. Combination of power and spectral brain Doppler indices could improve the prediction of emergency cesarean section for intrapartum fetal distress after labor induction in term, SGA fetuses. 5. Abnormal cerebral blood perfusion discriminates SGA fetuses at risk of abnormal neurobehavioral performance with a better sensitivity than spectral Doppler indices. To evaluate the contribution of fetal brain and cardiac Doppler parameters in identifying SGA fetuses with late-onset intrauterine growth restriction at risk of emergency cesarean section for intrapartum fetal distress and abnormal neonatal neurobehavioral performance. SPECIFIC OBJECTIVES: 1. To establish normal reference intervals of fetal regional brain blood perfusion using power Doppler ultrasound as measured by FMBV. 2. To construct normal reference ranges of left modified myocardial performance index in near-term fetuses. 3. To compare the temporal sequence of fetal brain hemodynamic changes in near-term SGA fetuses, as measured by spectral-Doppler indices or by FMBV. 4. To evaluate the changes in myocardial performance index, aortic isthmus and ductus venosus in term, SGA fetuses with normal umbilical artery Doppler. 5. To explore whether a combination of brain Doppler parameters could improve the prediction of emergency cesarean section for fetal distress and neonatal acidosis after labor induction in term SGA fetuses. 6. To evaluate changes in cerebral blood perfusion and middle cerebral artery Doppler in term SGA fetuses and to explore their association with neonatal neurobehavioral performance.