Abstract
This chapter reviews the clinical application of Doppler ultrasound velocimetry of the cerebral blood flow in the fetus. There are two main clinical applications of the fetal Doppler cerebral blood flow velocity waveforms:
1. Intrauterine growth restriction (IUGR) pregnancies
2. Diagnosis of fetal anemia
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References
Mari G, Moise KJ Jr, Deter RL et al. (1989) Doppler assessment of the pulsatility index in the cerebral circulation of the human fetus. Am J Obstet Gynecol 160:698–703
Mari G (1994) Regional cerebral flow velocity waveforms in the human fetus. J Ultrasound Med 13:343–346
Woo JK, Liang ST, Lo RS, Chan FY (1987) Middle cerebral artery Doppler flow velocity waveforms. Obstet Gynecol 70:613–616
Mari G, Deter RL (1992) Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses. Am J Obstet Gynecol 166:1262–1270
Mari G, Adrignolo A, Abuhamad AZ, Pirhonen J, Jones DC, Ludomirsky A, Copel JA (1995) Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization. Ultrasound Obstet Gynecol 5:400–405
Dobbing J, Sands J (1970) Timing of neuroblast multiplication in developing human brain. Nature 226:639–640
Cohn HE, Sacks EJ, Heymann MA, Rudolph AM (1974) Cardiovascular responses to hypoxemia and academia in fetal lambs. Am J Obstet Gynecol 120:817–824
Richardson BS, Rurak D, Patrick JE, Homan J, Carmichael L (1989) Cerebral oxidative metabolism during sustained hypoxaemia in fetal sheep. J Dev Physiol 11:37–43
Wladimiroff JW, Tonge HM, Stewart PA (1986) Doppler ultrasound assessment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol 93:471–475
Veille JC, Cohen I (1990) Middle cerebral artery blood flow in normal and growth-retarded fetuses. Am J Obstet Gynecol 162:391–396
Scherjon SA, Smolders-DeHaas H, Kok JH, Zondervan HA (1993) The “brain-sparing” effect: antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants. Am J Obstet Gynecol 169:169–175
Mari G, Abuhamad AZ, Keller M et al. (1996) Is the fetal brain-sparing effect a risk factor for the development of intraventricular hemorrhage in the preterm infant? Ultrasound Obstet Gynecol 8:329–332
Severi FM, Bocchi C, Visentin A et al. (2002) Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 19:225–228
Vyas S, Nicolaides KH, Bower S, Campbell S (1990) Middle cerebral artery flow velocity waveforms in fetal hypoxemia. Br J Obstet Gynaecol 97:797–803
Mari G, Wasserstrum N (1991) Flow velocity waveforms of the fetal circulation preceedings fetal demise in a case of lupus anticoagulant. Am J Obstet Gynecol 164:776–778
Sepulveda W, Peek MJ (1996) Reverse end-diastolic flow in the middle cerebral artery: an agonal pattern in the human fetus. Am J Obstet Gynecol 174:1645–1647
Konje JC, Bell SC, Taylor DJ (2001) Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: Is the occurrence of reversal of compensatory flow too late? Br J Obstet Gynaecol 108:973–979
Respondek M, Woch A, Kaczmarek P, Borowski D (1997) Reversal of diastolic flow in the middle cerebral artery of the fetus during the second half of pregnancy. Ultrasound Obstet Gynecol 9:324–329
Zeki S, Mehmet U, Hakan P (2003) Reversed diastolic flow in the middle cerebral artery: its clinical value in fetal growth restriction. Prenat Diagn 23:861–868
Leung WC, Tse KY, Tang MHY, Lao TT (2003) Reversed diastolic flow in the middle cerebral artery: Is it a terminal sign in a growth-retarded fetus? Prenat Diagn 23:265–267
Vyas S, Campbell S, Bower S, Nicolaides KH (1990) Maternal abdominal pressure alters fetal cerebral blood flow. Br J Obstet Gynaecol 97:740–747
Ozcan T, Sbracia M, d’Ancona RL et al. (1998) Arterial and venous Doppler velocimetry in the severely growth restricted fetus and associations with adverse perinatal outcome. Ultrasound Obstet Gynecol 12:39–44
Hecher K, Bilardo CM, Stigter RH et al. (2001) Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 18:564–570
Baschat AA, Gembruch U, Harman CR (2001) The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol 18:571–577
Ferrazzi E, Bozzo M, Rigano S et al. (2002) Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound Obstet Gynecol 19:140–146
Wladimiroff JW, van den Wijngaard JAC, Degani S et al. (1987) Cerebral and umbilical arterial blood flow velocity waveforms in normal and growth retarded pregnancies: a comparative study. Obstet Gynecol 69:705–709
Gramellini D, Folli MC, Raboni S et al. (1992) Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 79:416–420
Bahado-Singh R, Kovanci E, Jeffres A et al. (1999) The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth. Am J Obstet Gynecol 180:750–756
Makhseed M, Jirous J, Ahmed MA, Viswanathan DL (2000) Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome. Int J Gynecol Obstet 71:119–125
Stern G, Shields LE, Dubinsky TJ (2001) Abnormal fetal cerebral and umbilical Doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity. J Clin Ultrasound 29:146–151
Hershkovitz R, Kingdom JCP, Geary M, Rodeck CH (2000) Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 15:209–212
Harrington K, Thompson MO, Carpenter RG, Nguyen M, Campbell S (1999) Doppler fetal circulation in pregnancies complicated by pre-eclampsia or delivery of a small for gestational age baby: longitudinal analysis. Br J Obstet Gynaecol 106:453–466
Arduini D, Rizzo G, Romanini C, Mancuso S (1989) Fetal haemodynamic response to acute maternal hyperoxygenation as predictor of fetal distress in intrauterine growth retardation. Br Med J 298:1561–1562
Mari G, Deter RL, Carpenter RL et al. (2000) Non-invasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative group for Doppler assessment of the blood velocity in anemic fetuses. Engl J Med 342:9–14
Jauniaux E, Van Maldergem L, De Munter C et al. (1990) Nonimmune hydrops fetalis associated with genetic abnormalities. Obstet Gynecol 75:568–572
Murat OA, Gallagher PG (1995) Hematologic disorders and nonimmune hydrops fetalis. Semin Perinatol 19:502–515
Norton ME (1994) Nonimmune hydrops fetalis. Semin Perinatol 18:321–332
Chuff DH, Waye JS (1998) Hydrops fetalis caused by alpha-thalassemia: an emerging health care problem. Blood 91:2213–2222
Old J (1996) Haemoglobinopathies. Prenat Diagn 16: 1181–1186
Leung WC, Oepkes D, Seaward G, Ryan G (2002) Serial sonographic findings of four fetuses with homozygous alpha-thalassemia-1 from 21 weeks onwards. Ultrasound Obstet Gynecol 19:56–59
Owen J, Stedman CM, Tucker TL (1989) Comparison of predelivery versus postdelivery Kleihauer-Betke stains in cases of fetal death. Am J Obstet Gynecol 161:663–666
Giacoia GP (1997) Severe fetomaternal hemorrhage: a review. Obstet Gynecol Surv 52:372–380
Sueters M, Arabin B, Oepkes D (2003) Doppler sonography for predicting fetal anemia caused by massive fetomaternal hemorrhage. Ultrasound Obstet Gynecol 22:186–189
Tercanli S, Gembruch U, Holzgreve W (2000) Nonimmune hydrops fetalis in diagnosis and management. In: Callen PW (ed) Ultrasonography in obstetrics and gynecology, 4th edn. Saunders, Philadelphia, pp 563–566
Mentzer WC, Collier E (1975) Hydrops fetalis associated with erythrocyte G-6-PD deficiency and maternal ingestion of fava beans and ascorbic acid. J Pediatr 86:565–567
Perkins RP (1971) Hydrops fetalis and stillbirth in a male glucose-6-phosphate dehydrogenase-deficient fetus possibly due to maternal ingestion of sulfisoxazole: a case report. Am J Obstet Gynecol 111:379–381
Brown KE, Anderson SM, Young NS (1993) Erythrocyte P antigen: cellular receptor for B19 parvovirus. Science 262:114–117
Haak MC, Oosterhof H, Mouw RJ et al. (1999) Pathophysiology and treatment of fetal anemia due to placental chorioangioma. Ultrasound Obstet Gynecol 14: 68–70
Rogers BB, Bloom SL, Buchanan GR (1997) Autosomal dominantly inherited Diamond-Blackfan anemia resulting in nonimmune hydrops. Obstet Gynecol 89:805–807
McLennan AC, Chitty LS, Rissik J, Maxwell DJ (1996) Prenatal diagnosis of Blackfan-Diamond syndrome: case report and review of the literature. Prenat Diagn 16:349–353
Mari G, Deter RL, Carpenter R et al. (1990) The peak systolic velocity of the middle cerebral artery is a better indicator of fetal anemia than the pulsatility index. Proc Soc Gynecologic Investigation, St. Louis, Missouri
Zimmerman R, Durig P, Carpenter RJ Jr, Mari G (2002) Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicenter trial with intention-totreat. Br J Obstet Gynaecol 109:746–752
Nishie EN, Brizot ML, Liao AW et al. (2003) A comparison between middle cerebral artery peak systolic velocity and amniotic fluid optical densityat 450 nm in the prediction of fetal anemia. Am J Obstet Gynecol 188:214–219
Mari G, Penso C, Sbracia M et al. (1997) Delta OD 450 and Doppler velocimetry of the middle cerebral artery peak velocity in the evaluation for fetal alloimmune hemolytic disease. Which is best? Am J Obstet Gynecol 176:S18
Pereira L, Jenkins TM, Berghella V (2003) Conventional management of maternal red cell alloimmunization compared with management by Doppler assessment of middle cerebral artery peak systolic velocity. Am J Obstet Gynecol 189:1002–1006
Mari G, Detti L, Oz U et al. (2002) Accurate prediction of fetal hemoglobin by Doppler ultrasonography: a preliminary study. Obstet Gynecol 99:589–593
Stefos T, Cosmi E, Detti L, Mari G (2002) Correction of fetal anemia and the middle cerebral artery peak systolic velocity. Obstet Gynecol 99:211–215
Detti L, Oz U, Guney I et al. (2001) Doppler ultrasound velocimetry for timing the second intrauterine transfusion in fetuses with anemia from red cell alloimmunization. Am J Obstet Gynecol 185:1048–1051
Delle Chiaie LD, Buck G, Grab D, Terinde R (2001) Prediction of fetal anemia with Doppler measurement of the middle cerebral artery peak systolic velocity in pregnancies complicated by maternal blood group alloimmunization or parvovirus B19 infection. Ultrasound Obstet Gynecol 18:232–236
Teixeira JM, Duncan K, Letsky E, Fisk NM (2000) Middle cerebral artery peak systolic velocity in the prediction of fetal anemia. Ultrasound Obstet Gynecol 15: 205–208
Deren O, Onderoglu L (2002) The value of middle cerebral artery systolic velocity for initial and subsequent management in fetal anemia. Eur J Obstet Gynecol Reprod Biol 101:26–30
Abdel-Fattah SA, Soothill PW, Carroll SG, Kyle PM (2002) Middle cerebral artery Doppler for the prediction of fetal anemia in cases without hydrops: a practical approach. Br J Radiol 75:726–730
Chmait RH, Hull AD (2002) Doppler ultrasonographic evaluation of twins discordant for Rh alloimmunization. Am J Obstet Gynecol 187:250–251
Detti L, Mari G, Akiyama M et al. (2002) Longitudinal assessment of the middle cerebral artery peak systolic velocity in healthy fetuses and in fetuses at risk for anemia. Am J Obstet Gynecol 187:937–939
Detti L, Mari G (2003) Noninvasive diagnosis of fetal anemia. Clin Obstet Gynecol 46:923–930
Moise KJ Jr (2002) Management of rhesus alloimmunization in pregnancy. Obstet Gynecol 100:600–611
Cosmi E, Mari G, Delle Chiaie L et al. (2002) Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection. Am J Obstet Gynecol 187:1290–1293
Mari G, Detti L (2001) Doppler ultrasound: application to fetal medicine. In: Fleischer AC, Manning AF, Jeanty P, Romero R (eds) Sonography in obstetrics and gynecology: principles and practice, 6th edn. McGraw-Hill, New York, pp 274–276
Senat MV, Loizeau S, Couderc S, Bernard JP, Ville Y (2003) The value of middle cerebral artery peak systolic velocity in the diagnosis of fetal anemia after intrauterine death of one monochorionic twin. Am J Obstet Gynecol 189:1320–1324
Abel DE, Grambow SC, Brancazio LR, Hertzberg BS (2003) Ultrasound assessment of the fetal middle cerebral artery peak systolic velocity: a comparison of the near-field versus the far-field vessel. Am J Obstet Gynecol 189:986–989
Akiyama M, Detti L, Abuhamad A, Bahado-Singh R, Mari G (2002) Is the middle cerebral artery peak systolic velocity measurement affected by the site of vessel sampling? Am J Obstet Gynecol 187:S164
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Detti, L., Segata, M., Mari, G. (2005). Cerebral Blood Flow Velocity Waveforms: Clinical Application. In: Maulik, D. (eds) Doppler Ultrasound in Obstetrics and Gynecology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-28903-8_14
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DOI: https://doi.org/10.1007/3-540-28903-8_14
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-23088-5
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