Düşük Riskli Üçüncü Trimester Gebelerde Fetal Doppler İncelemenin Doğum Ağırlığı ile İlişkisi

Abstract

Amaç: Bu çalışmada spontan vaginal doğum yapmış, düşük riskli term gebelerde doğum öncesi bakılan obstetrik Doppler ölçümleri ile fetal doğum ağırlığı arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve yöntemler: Çalışma kesitsel bir çalışma olup prospektif dizayn edilmiştir.. Çalışmaya 18-45 yaş arasında, 37-41 gebelik haftasında olan ve başvuru anından itibaren 72 saat içerisinde doğum yapmış tekiz gebeler dahil edilmiştir. Doğum öncesi bakılan umblikal arter (UA), uterin arter (UtA) ve orta serebral arter (MCA) Doppler değerleri ile doğum kilosu ilişkisi araştırılmıştır. Bulgular: Çalışmaya toplam 134 hasta dâhil edildi. Hastaların ortalama yaşı 26,3 ± 6,1 olup, gebelik haftaları ise 39 (37-41) olarak bulundu. UA PI, RI ve S/D oranları ile doğum kilosu arasında istatistiksel olarak anlamlı olmayan, negatif yönlü orta derecede korelasyon izlenmiştir. Ortalama UtA PI ile fetal kilo arasında zayıf, pozitif yönlü ve istatistiksel olarak anlamlı olan ilişki bulunmuştur (r=0,270; p=0,002). Gebelik haftasına göre düzeltme yapıldığında ortalama UtA RI ile fetal kilo arasında zayıf, negatif yönlü ve istatistiksel olarak anlamlı ilişki bulunmuştur (r=-0,245; p=0,004). Serebroplasental oran (CPR) ile doğum ağırlığı arasında gebelik haftasından bağımsız zayıf pozitif ilişki bulunmuştur (r=0,054; p=0,539) Sonuç: Çalışmamızda gebelik haftasından bağımsız olarak üçüncü trimester düşük riskli gebeliklerde artmış UtA rezistansı ile düşük doğum ağırlığı ilişkili bulunmuştur. UA, MCA ve CPR ile doğum kilosu arasında gebelik haftası düzeltilse de güçlü bir ilişki gözlenmedi.

Keywords

• doğum ağırlığı
• Doppler ultrason
• gebelik
• umblikal arter
• uterin arter

The relation with the assesment of fetal Doppler and birth weight in low risk third trimester pregnancies

Abstract

Aim: In this study, we aimed to investigate the relationship between prenatal obstetric Doppler measurements and fetal birth weight in low risk term pregnant women who had spontaneous vaginal delivery. Material and Methods: This study is a prospective cross-sectional study. Singleton pregnant women between the ages of 18-45 who had 37-41 weeks of gestation and who gave birth within 72 hours from the admission to the hospital were included in the study. The relationship between birth weight and the Doppler values of the umbilical artery (UA), uterine artery (UtA) and middle cerebral artery (MCA) were investigated. Results: A total of 134 patients were included in the study. The mean age of the patients was 26.3 ± 6.1 years, and the median gestational week was found 39 weeks (37-41). There was a moderate negative correlation between the UA PI, RI and S / D ratios and birth weight, which was not statistically significant. A weak, positive and statistically significant relationship was found between the mean UtA PI and fetal weight (r = 0.270; p = 0.002).After adjusting the gestational week, a weak, negative and statistically significant relationship was found between the mean UtA RI and fetal weight (r = -0.245; p = 0.004). There was a weak positive relation between cerebroplasental ratio (CPR) and birth weight (r=0,054; p=0,539). Conclusion: In our study, raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight in low risk third trimester pregnant women. There was not a significant relationship between UA, MCA and CPR even after adjusting the gestational week.

Keywords

• birth weight
• Doppler ultrasound
• umblical artery
• uterine artery
• pregnancy

References

1. 1. SARIKAYA E, Özay O. Patolojik Umbilikal Arter Doppler Akım Paterni Tesbit Edilen Gebeliklerde Görülen Fetal Anomaliler. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2014;11(2):41-5.
2. 2. Drukker L, Staines-Urias E, Villar J, Barros FC, Carvalho M, Munim S, et al. International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21(st) Project. Am J Obstet Gynecol. 2020;222(6):602.e1-.e15.
3. 3. Ohno Y, Ando H, Tanamura A, Kurauchi O, Mizutani S, Tomoda Y. The value of Doppler ultrasound in the diagnosis and management of twin-to-twin transfusion syndrome. Arch Gynecol Obstet. 1994;255(1):37-42.
4. 4. Khalil A, Thilaganathan B. Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term. Best Pract Res Clin Obstet Gynaecol. 2017;38:38-47.
5. 5. Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RP. Is Doppler ultrasound useful for evaluating gestational trophoblastic disease? Clinics (Sao Paulo). 2015;70(12):810-5. 6. Sehgal N. Efficacy of Color Doppler Ultrasonography in Differentiation of Ovarian Masses. J Midlife Health. 2019;10(1):22-8.
6. 7. Alfirevic Z, Stampalija T, Medley N. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev. 2015;2015(4):Cd001450.
7. 8. Özel A, Şen C. First-trimester uterine artery Doppler: does it matter if the bladder is full or empty? Perinatal Journal/Perinatoloji Dergisi. 2019;27(3).
8. 9. Jamal A, Moshfeghi M, Molaei B, Moradi Y, Hashemi N. The effect of vaginal progesterone on Doppler findings in increased uterine artery resistance. J Matern Fetal Neonatal Med. 2019:1-4.

9. 10. Çintesun E, İncesu Çintesun FN, Mammadova N, Çelik Ç. The influence of vaginal progesterone on Uterine Artery Pulsatility Index. Ginekol Pol. 2021.
10. 11. Tutus S, Asal N, Uysal G, Şahin H. Is there a relationship between high birth weight and umbilical vein diameter? J Matern Fetal Neonatal Med. 2020:1-5.
11. 12. Lam H, Leung WC, Lee CP, Lao TT. Relationship between cerebroplacental Doppler ratio and birth weight in postdates pregnancies. Ultrasound Obstet Gynecol. 2005;25(3):265-9.
12. 13. Picklesimer AH, Oepkes D, Moise KJ, Jr., Kush ML, Weiner CP, Harman CR, et al. Determinants of the middle cerebral artery peak systolic velocity in the human fetus. Am J Obstet Gynecol. 2007;197(5):526.e1-4.
13. 14. Sankaran S, Prefumo F, Papageorghiou A, Thilaganathan B, Bhide A. Association of uterine artery Doppler resistance index and birth weight: effect of customized birth weight standards. Am J Perinatol. 2009;26(7):501-5.
14. 15. Berkley E, Chauhan SP, Abuhamad A, Committee SfM-FMP. Doppler assessment of the fetus with intrauterine growth restriction. American journal of obstetrics and gynecology. 2012;206(4):300-8.
15. 16. https://fetalmedicine.org/research/doppler.
16. 17. Al Hamayel NA, Baghlaf H, Blakemore K, Crino JP, Burd I. Significance of abnormal umbilical artery Doppler studies in normally grown fetuses. Matern Health Neonatol Perinatol. 2020;6:1.
17. 18. Prefumo F, Fichera A, Fratelli N, Sartori E. Fetal anemia: Diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2019;58:2-14.
18. 19. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PMM, Mol BWJ, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(3):313-22.
19. 20. Owen P, Murphy J, Farrell T. Is there a relationship between estimated fetal weight and umbilical artery Doppler impedance indices? Ultrasound Obstet Gynecol. 2003;22(2):157-9. 21. Kingdom J, Huppertz B, Seaward G, Kaufmann P. Development of the placental villous tree and its consequences for fetal growth. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):35-43.
20. 22. Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018;218(2s):S745-s61.
21. 23. Barrientos G, Pussetto M, Rose M, Staff AC, Blois SM, Toblli JE. Defective trophoblast invasion underlies fetal growth restriction and preeclampsia-like symptoms in the stroke-prone spontaneously hypertensive rat. Mol Hum Reprod. 2017;23(7):509-19.
22. 24. Sarmiento A, Casasbuenas A, Rodriguez N, Angarita AM, Sarmiento P, Sepulveda W. First-trimester uterine artery Doppler velocimetry in the prediction of birth weight in a low-risk population. Prenat Diagn. 2013;33(1):21-4.
23. 25. Hollis B, Prefumo F, Bhide A, Rao S, Thilaganathan B. First-trimester uterine artery blood flow and birth weight. Ultrasound Obstet Gynecol. 2003;22(4):373-6.