Is Middle Cerebral Artery Doppler a Reliable Tool for Fetal Monitoring? A Prospective Observational Study on Intra...

Area of Science:

• Perinatal medicine
• Fetal ultrasonography
• Doppler velocimetry

Background:

• Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality.
• Accurate monitoring of FGR is crucial for timely intervention.
• Middle cerebral artery (MCA) pulsatility index (PI) is a key Doppler parameter used in FGR assessment.

Purpose of the Study:

• To evaluate the intra- and inter-observer variability of MCA pulsatility index (PI) measurements.
• To compare MCA PI variability in pregnancies with FGR versus normally grown fetuses.
• To review existing literature on MCA PI reproducibility in FGR.

Main Methods:

• Prospective observational cross-sectional study including singleton pregnancies (26-40 weeks).
• Patients categorized into FGR (early and late onset) and appropriately grown (AGA) groups.
• Intraclass Correlation Coefficient (ICC) used to assess intra- and inter-observer variability, adhering to TRUST criteria and GRRAS guidelines.

Main Results:

• 150 patients included; 48 with FGR (27 early, 21 late).
• MCA PI reproducibility was poor in AGA fetuses.
• Reproducibility was moderate/poor in FGR fetuses, but good for intraobserver and moderate for interobserver in early-onset FGR.

Conclusions:

• MCA PI Doppler measurements demonstrate superior repeatability in fetuses with FGR compared to AGA fetuses.
• MCA PI can be reliably used for monitoring FGR, especially in early-onset cases.
• Improved understanding of MCA PI variability aids in clinical decision-making for FGR management.