Department of Maternal-Fetal Medicine, Institute Clinic for Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER), Barcelona, Spain.
Ultrasound Obstet Gynecol. 2010 Apr;35(4):456-61. doi: 10.1002/uog.7588.
To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler.
MCA and ACA Doppler ultrasonography was performed in a cohort of SGA term fetuses with normal UA Doppler. Perinatal outcome and neonatal neurobehavioral performance were compared with a group of term appropriate-for-gestational age (AGA) infants. Neurobehavior was evaluated at 40 ( +/- 1) weeks of corrected age with the Neonatal Behavioral Assessment Scale. Differences between the study groups were adjusted for potential confounding variables by multiple linear or logistic regression analyis.
A total of 199 newborns (98 SGA and 101 AGA) were included. Among the SGA fetuses, 28.6 and 17% had MCA and ACA redistribution, respectively. Cases with either type of redistribution had an increased risk for adverse outcome, with no differences in predictive performance between the two parameters. SGA fetuses with MCA redistribution compared with controls had an increased risk for abnormal neurobehavioral performance in motor (36 vs. 20%; adjusted P = 0.02) and state organization (25 vs. 17.5%; adjusted P = 0.03) areas. SGA fetuses with ACA redistribution had only an increased risk for abnormal neurobehavioral performance area in state organization compared with controls (30 vs. 17.5%; adjusted P = 0.021).
In term SGA newborns with no signs of brain-sparing, ACA Doppler investigation does not provide any benefit over MCA in terms of the prediction of adverse perinatal outcome.
评估大脑前动脉（ACA）多普勒超声是否优于大脑中动脉（MCA）多普勒超声，用于预测正常脐动脉（UA）多普勒的足月小胎龄（SGA）胎儿的围产结局和新生儿神经行为。
对一组正常 UA 多普勒的足月 SGA 胎儿进行 MCA 和 ACA 多普勒超声检查。将围产结局和新生儿神经行为表现与一组足月适当胎龄（AGA）婴儿进行比较。神经行为在校正年龄 40（ +/- 1）周时使用新生儿行为评估量表进行评估。通过多元线性或逻辑回归分析，对研究组之间的差异进行潜在混杂变量调整。
共纳入 199 名新生儿（98 名 SGA 和 101 名 AGA）。在 SGA 胎儿中，MCA 和 ACA 再分布分别占 28.6%和 17%。存在任何一种再分布的病例发生不良结局的风险增加，但两种参数的预测性能无差异。与对照组相比，MCA 再分布的 SGA 胎儿在运动（36%比 20%；调整后 P=0.02）和状态组织（25%比 17.5%；调整后 P=0.03）区域的神经行为异常风险增加。与对照组相比，仅 ACA 再分布的 SGA 胎儿在状态组织中神经行为异常风险增加（30%比 17.5%；调整后 P=0.021）。
在没有脑保护迹象的足月 SGA 新生儿中，ACA 多普勒检查在预测不良围产结局方面与 MCA 相比没有任何优势。
