DOPPLER INDICES IN MONITORING FETUSES WITH LATE ONSET OF INTRAUTERINE FETAL GROWTH RESTRICTION

Objective: to study the longitudinal trends in the transformation of blood flow parameters from normal to abnormal values in fetuses with late onset of intrauterine fetal growth restriction - from the moment of diagnosis to delivery.Patients and methods: We performed longitudinal analysis of changes in uterine artery pulsatility index (UtA-PI), umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA- PI), and cerebro-placental ratio (CPR) in a cohort of women with singleton pregnancies and small for gestational age fetuses. Longitudinal changes were analyzed by Kaplan-Meier method. The McNemar test was used to compare inter-group proportions. Stata V14.2 package (StataCorp LLC) was used for statistical analysis. p-value less than 0.05 (typically ≤ 0.05) was considered as statistically significant Results: A cohort of 53 women was formed, and total of 156 Doppler were available for analysis. There was a statistically significant difference between MCA-PI (7.5 vs. 18.8%; P = 0.03) and CPR (9.4 vs. 36.4%; P = 0.01) indices. The residual proportion of normal values of UtA-PI, UA-PI, MCA-PI, and CPR at 40 weeks of gestation were respectively 96.2 (95% CI 81.3-100), 92.4 (95% CI 77, 3-100), 83 (95% CI 67.9-92.4), 43.4% (95% CI 33.9-73.5).Conclusions: In fetuses with IUGR, starting from the 37th week of gestation, a progressive deterioration of cerebro-placental ratio and vasodilation of the middle cerebral artery is observed. In this regard, the assessment of the cerebro-placental ratio, as a sensitive Doppler indicator, may be useful for monitoring fetuses with a late onset of IUGR.

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