Saynur Sarıcı YILMAZ, Deniz HIZLI, Ragıp ATAKANl, ETHEM SERDAR YALVAÇ, Ömer KANDEMİR

The Cerebroplacental Doppler Ratio and Neonatal Outcome in Suspected Small-for Gestational-Age Fetuses with Normal Umbilical Artery Doppler

Amaç: Umbilikal ya da serebral arter Doppler kan akımı normal olsa da düşük doğum ağırlıklı (SGA) fetuslar kötü perinatal sonuç açısından risk altındadır. Serebroplasental oran (CPR) orta serebral arter (MCA) pulsatilite indeksi (PI) veya rezistans indeksinin (RI) umbilikal arter (UA) değerlerine oranlanması ile elde edilir ve SGA fetuslarda kötü perinatal sonuçları öngördüğü düşünülmektedir. Bu çalışmanın amacı SGA şüphesiyle takip edilen UA doppler değerleri normal olan gebelerde serebroplasental oranın fetal sonuçları ve doğum kilosunu öngörmedeki yerini araştırmaktır. Materyal ve Metot: Bu prospektif çalışma 2005-2006 yılllarında Ankara Zübeyde Hanım Kadın Sağlığı Eğitim ve Araştırma hastanesinde yapılmıştır. Toplam 94 hasta çalışma kriterlerine uygun bulunmuştur. Serebroplasental oran pulsatilite indeksi kullanılarak matematiksel olarak hesaplanmıştır (MCA PI/UA PI). Doğum öncesinde son kaydedilen değerler istatistiksel analiz için kullanılmıştır. Bulgular: Yenidoğanların 54 (%58) tanesinin doğum kilosu 10 persentilin altında bulunmuştur. Toplam 10 (%10,6) yenidoğan yoğun bakıma (NICU) kabul edilmiştir. Yoğun bakıma kabul edilme ile CPR arasında bir ilişki saptanmazken (p=0,63), CPRnin fetal ağırlığın 2500 gden küçük olduğunu öngörmede anlamlı olduğu bulunmuştur (p=0,0085). Sonuçlar: Sonuç olarak CPR, SGA şüphesiyle takip edilen gebelerin izleminde kullanılabilir.

(Normal umbilikal arter doppleri olan düşük doğum ağırlığı şüphesiyle takip edilen fetuslarda neonatal sonuçları öngörmede serebroplasental doppler oranının yeri)

Background: Small-for-gestational age (SGA) fetuses have an increased risk of adverse perinatal outcome even if Doppler flows of umbilical artery or cerebral artery are normal. The cerebroplacental ratio (CPR), a ratio of the pulsatility index (PI) or resistance index (RI) of middle cerebral artery (MCA) to the index of umbilical artery (UA), has been suggested as a useful parameter for predicting adverse outcomes in SGA. The objective of our study was to assess the value of the cerebroplacental ratio in predicting the outcome and birth weight of suspected SGA fetuses with normal UA Doppler waveforms. Material and Methods: The prospective study was undertaken between 2005-2006 at Zubeyde Hanim Womens Health Research and Teaching Hospital, Ankara. A total of 94 patients met the inclusion criteria of the study. Cerebroplacental ratio was calculated mathematically by using pulsatility index (MCA PI/UA PI). The last recorded values before delivery was used for statistical analyses. Results: Birth weight of 54 infants (58%) was <10th percentile. Total of 10 (10,6%) newborns were admitted the neonatal intensive care unit (NICU). We found no predictive value of CPR on NICU admission (p= 0,63). On the other hand, CPR was significantly predictive for birth weight <2500 g (p=0,085). Conclusions: In conclusion the CPR need to be used in prenatal monitoring of pregnancies with suspected SGA.

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