Integrated 2D Doppler indices of uteroplacental and fetal blood flow in diagnosis of intrauterine hypoxia

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Relevance . Intrauterine hypoxia associated with placental disorders is a significant factor of ante-, intra- and postnatal fetal and newborn death. Despite clinical examination of pregnant women using ultrasound and cardiotocography, cases of intrauterine hypoxia often remain undetected prenatally. Clinical manifestation of placental disorders and intrauterine hypoxia are associated with pathological changes of blood flow resistance in the uterine, placental and fetal vessels. A combined Doppler assessment of blood flow in the uterine, placental and fetal vessels could improve detection of intrauterine hypoxia. The aim of the study was to assess the prognostic significance of integrated 2D Doppler indices of uteroplacental and fetal blood flow for the detection of fetal hypoxia in the 3rd trimester and to predict unfavorable perinatal outcomes. Materials and Methods. The outcomes of pregnancy of 48 women with fetal hypoxia delivered at 29 - 40 gestational weeks (study group), and 21 women who gave birth to healthy full-term infants (control group) were retrospectively analyzed. On the eve of delivery all women had 2D Doppler assessment of the uterine arteries, umbilical arteries, and fetal middle cerebral artery with an assessment of the cerebro-placental ratio, umbilical-cerebral ratio and cerebro-placental-uterine ratio. Results and Discussion . Analysis of the obtained values of cerebro-placental-uterine ratio, cerebro-placental ratio and umbilical-cerebral ratio showed the benefit from use of integrated 2D Doppler indices in the diagnosis of fetal hypoxia at 29 - 40 gestations’ weeks and in predicting complications in newborns. The high sensitivity of the cerebro-placental-uterine ratio (90.5%) makes it possible to effectively use this index for the diagnosis of intrauterine hypoxia. Conclusion. Pathological cerebro-placental-uterine ratio < 2.44 is a clinically significant 2D Doppler criterion that predicts a high risk of asphyxia, respiratory distress syndrome, hypotrophy, and perinatal hypoxic-ischemic encephalopathy. Lower values of the cerebro-placental ratio and umbilical-cerebral ratio sensitivity (77.1% and 81.3%, respectively) limit their use for the diagnosis of fetal hypoxia as compared with cerebro-placental-uterine ratio.

About the authors

Natallia V. Matskevich

Vitebsk State Order of Peoples’ Friendship Medical University

Author for correspondence.
ORCID iD: 0000-0001-9650-8113
Vitebsk, Republic of Belarus

Marina P. Famina

Vitebsk State Order of Peoples’ Friendship Medical University

ORCID iD: 0000-0001-9088-4126
Vitebsk, Republic of Belarus


  1. Dobrokhotova YE, Johadze LS, Kuznetsov PA, Kozlov PV. Placental insufficiency. Modern view. M.: GEOTAR-Media. 2019:64 p. (in Russian)
  2. Fomina MP, Divakova TS. Ultrasound diagnostics in assessing the condition of the fetus in placental disorders and pregnancy management tactics. Monograph. Vitebsk: VSMU. 2016:369 p. (in Russian)
  3. Kuznetsov RA, Peretyatko LP, Rachkova OV. Morphological criteria of ptimary placental insufficiency. RUDN Journal of Medicine. 2011; S5:34-39. (in Russian)
  4. Trokhanova OV, Guryev DL, Gurieva DD, Ermolina EA, Matveev IM, Martyanova MV. Neonatal and postneonatal outcomes in various disorders of fetoplacental blood flow. Doctor.RU. 2018;10(154):10-17. (in Russian)
  5. Khalil A. Is cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am.J. Obstet. Gynecol. 2015;213(1):54-60. doi: 10.1016/j. ajog.2014.10.024.
  6. Akolekar R. Umbilical and fetal middle cerebral artery Doppler at 35-37 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet. Gynecol. 2015;46(1):82-92. doi: 10.1002/uog.14842.
  7. Parry E. New Zealand Obstetric Doppler Guideline. New Zealand Maternal Fetal Medicine Network (NZMFMN). 2013;16 p.
  8. Morales-Rosello J. Poor neonatal acid-base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet. Gynecol. 2015;45:156-161. doi: 10.1002/uog.14647.
  9. Clegg J. Arterial line blood sampling: Neonatal clinical Guideline. Royal Cornwall Hospitals, NHS Trust. 2014;53 p. The internet source: http: // / Documents Library / Royal Cornwall Hospitals Trust / Clinical / Neonatal / Arterial Sampling Neonatal Guideline.pdf.
  10. Eremina OV. Study of blood from fetal presenting part in assessing of fetal condition during childbirth. Obstetrics and gynecology. 2011;8:16-20. (in Russian)
  11. Akolekar R. Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history. Ultrasound Obstet. Gynecol. 2015;45:402-408. doi: 10.1002/ uog.14824.
  12. Baschat AA. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet. Gynecol. 2003;21:124-127. doi: 10.1002/uog.20.
  13. Khalil A. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? Am.J. Obstet Gynecol. 2017;216(6):606-610. doi: 10.1016/j.ajog.2017.02.005.
  14. Acharya G, Ebbing C, Karlsen H. O, Kiserud T, Rasmussen S. Sex-specific reference ranges of cerebroplacental and umbilicocerebral ratios. Ultrasound Obstet. Gynecol. 2019;10:187-195. doi: 10.1002/ uog.21870.
  15. Gomes O. Reference ranges for uterine mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet. Gynecol. 2008;32:128-132. doi: 10.1002/uog.5315.
  16. MacDonald T.M., Hui L., Robinson A.J., Dane K.M., Middleton A. L., Tong S. Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study. Ultrasound Obstet. Gynecol. 2019;54:375-367. doi: 10.1002/ uog.20150.
  17. Strizhakov AN. Dopplerometry and Doppler echocardiographic study of the nature and staging of fetal hemodynamic disorders at fetal growth restriction. Obstetrics and gynecology. 1992;1:22-26. (in Russian)
  18. Artymuk NV. Informativeness of functional diagnostics’ methods on chronic placental insufficiency. Protection of motherhood and childhood. 2009;1(13):32-37. (in Russian)
  19. Fillipov OS. Placental insufficiency. M. 2009:160 p. (in Russian)

Copyright (c) 2021 Matskevich N.V., Famina M.P.

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