Middle cerebral arterial flow redistribution is an indicator for intrauterine fetal compromise in late pregnancy in low-resource settings: a prospective cohort study
Ali, Sam; Kawooya, Michael G; Byamugisha, Josaphat; Kakibogo, Isaac M; Biira, Esther A; Kagimu, Adia N; Grobbee, Diederick E; Zakus, David; Papageorghiou, Aris T; Klipstein-Grobusch, Kerstin; Rijken, Marcus J
(2022) BJOG - An International Journal of Obstetrics and Gynaecology, volume 129, issue 10, pp. 1712 - 1720
(Article)
Abstract
Objective: We aimed to determine the prevalence of abnormal umbilical artery (UA), uterine artery (UtA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR) Doppler, and their relationship with adverse perinatal outcomes in women undergoing routine antenatal care in the third trimester. Design: Prospective cohort. Setting: Kagadi Hospital, Uganda. Population: Non-anomalous
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singleton pregnancies. Methods: Women underwent an early dating ultrasound and a third-trimester Doppler scan between 32 and 40 weeks of gestation, from 2018 to 2020. We handled missing data using multiple imputation and analysed the data using descriptive methods and a binary logistic regression model. Main outcome measures: Composite adverse perinatal outcome (CAPO), perinatal death and stillbirth. Results: We included 995 women. The mean gestational age at Doppler scan was 36.9 weeks (SD 1.02 weeks) and 88.9% of the women gave birth in a health facility. About 4.4% and 5.6% of the UA pulsatility index (PI) and UtA PI were above the 95th percentile, whereas 16.4% and 10.4% of the MCA PI and CPR were below the fifth percentile, respectively. Low CPR was strongly associated with stillbirth (OR 4.82, 95% CI 1.09–21.30). CPR and MCA PI below the fifth percentile were independently associated with CAPO; the association with MCA PI was stronger in small-for-gestational-age neonates (OR 3.75, 95% CI 1.18–11.88). Conclusion: In late gestation, abnormal UA PI was rare. Fetuses with cerebral blood flow redistribution were at increased risk of stillbirth and perinatal complications. Further studies examining the predictive accuracy and effectiveness of antenatal Doppler ultrasound screening in reducing the risk of perinatal deaths in low- and middle-income countries are warranted. Tweetable abstract: Blood flow redistribution to the fetal brain is strongly associated with stillbirths in low-resource settings.
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Keywords: Perinatal Mortality, low resource setting, ultrasound doppler, screening, cerebroplacental ratio, developing countries, prediction, stillbirth, perinatal death, Doppler ultrasound, prenatal care, Obstetrics and Gynaecology, Journal Article
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Funding Information: The study received funding from Grand Challenges Canada (ref. no. R-ST-POC-1808-17 038) and the University Medical Center Utrecht (ref. no. FM/ADB/D- 18-015006). The funders had no role in the study design, data collection, data analysis or writing of the article. We are grateful to the women and teams from Kagadi district, ECUREI and Makerere University College of Health Sciences, who supported the EPID study. The University of Oxford, Oxford, UK, provided the ultrasound equipment used for data collection. We further thank Fosca Tumushabe for her support with the English language review. We extend immense gratitude to the study funders (Grand Challenges Canada and the UMC Utrecht Global Health Support Program). ATP is supported by the Oxford Partnership Comprehensive Biomedical Research Centre, with funding from the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) funding scheme. Funding Information: The study received funding from Grand Challenges Canada (ref. no. R‐ST‐POC‐1808‐17 038) and the University Medical Center Utrecht (ref. no. FM/ADB/D‐ 18‐015006). The funders had no role in the study design, data collection, data analysis or writing of the article. Funding information Funding Information: SA reports grants from Grand Challenges Canada and University Medical Center Utrecht, Utrecht, The Netherlands, and ultrasound equipment support from the University of Oxford, Oxford, United Kingdom. ATP reports research grants from UK, European and USA research councils and charities: the NIHR / HTA, NIHR Oxford Biomedical Research Centre, EPSRC, GCRF, ERC, NIH and Bill and Melinda Gates Foundation; personal fees and support from Capital Medical University, Beijing; Ministry of Health, Cyprus; from GE Healthcare; and Samsung Medison. ATP holds a patent entitled “A system and method are provided to automatically categorize biological and medical images” US10762630B2, and is a senior advisor for Intelligent Ultrasound. The remaining authors have no disclosures. Completed disclosure of interests form available to view online as supporting information. Funding Information: We are grateful to the women and teams from Kagadi district, ECUREI and Makerere University College of Health Sciences, who supported the EPID study. The University of Oxford, Oxford, UK, provided the ultrasound equipment used for data collection. We further thank Fosca Tumushabe for her support with the English language review. We extend immense gratitude to the study funders (Grand Challenges Canada and the UMC Utrecht Global Health Support Program). ATP is supported by the Oxford Partnership Comprehensive Biomedical Research Centre, with funding from the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) funding scheme. Publisher Copyright: © 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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