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Journal Club: Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study.

Journal Club: Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study.
Citation: Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK.
Med J Armed Forces India. 2017 Jul;73(3):232-241. 
doi:10.1016/j.mjafi.2016.12.008. Epub 2017 Jan 17.

BACKGROUND: Doppler indices form an integral component of noninvasive evaluation 
of fetal well-being. There is paucity of information about normal obstetric 
Doppler indices, particularly from the Indian subcontinent. The aim of the study 
was to find the values of pulsatility index (PI), resistive index (RI) of 
umbilical artery (UA), and fetal middle cerebral artery (MCA) and calculate
cerebro-placental ratio (CP ratio) for 18-40 weeks of normal gestation so that a
reference range of these Doppler values can be postulated.
METHODS: 200 patients were enrolled in the study for color Doppler study of UA 
and MCA and were serially followed up at 4-6 weeks interval for Doppler indices. 
Angle-independent Doppler indices like PI and RI for MCA and UA were obtained 
during each examination. CP ratio was calculated in each case. All the cases were
followed up till delivery and the perinatal outcome was recorded.
RESULTS & CONCLUSION: The fetal MCA PI and RI showed a parabolic curve with 
plateau at 28-30 weeks of gestation. A significant correlation was noted between 
MCA PI and RI with gestational age. UA PI and RI showed a gradual fall over the 
gestational age with a strong negative correlation. There was a significant
correlation between MCA PI and UA PI with their respective RI values. CP ratio 
has also shown a parabolic curve with turning point at 31-32 weeks of gestation. 
A significant correlation was noted between CP ratio and gestational age. CP ratio
also showed a minimal positive correlation with MCA PI and a strong negative 
correlation with UA PI.

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