Beyond the middle cerebral artery: anterior and posterior cerebral artery doppler provide complementary prognostic ınformation in late-onset fetal growth restriction.

内容摘要

To evaluate the association of anterior cerebral artery (ACA) and posterior cerebral artery (PCA) Doppler parameters with adverse perinatal outcomes in pregnancies complicated by late-onset fetal growth restriction (FGR), and assess their potential complementary prognostic role alongside conventional middle cerebral artery (MCA) Doppler assessment. This prospective observational study included 130 pregnancies diagnosed with late-onset FGR between 32 and 37&#xa0;weeks of gestation at a tertiary perinatology center. Doppler evaluation included umbilical artery (UA), uterine artery, MCA, ACA, and PCA. The cerebroplacental ratio (CPR) was calculated as MCA PI/UA PI. The primary outcome was composite adverse perinatal outcome defined as perinatal death, 5-min Apgar score&#x2009;<7, umbilical artery pH&#x2009;<&#x2009;7.20, neonatal intensive care unit (NICU) admission, or need for mechanical ventilation. Predictive performance of Doppler parameters was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Composite adverse perinatal outcomes occurred in 45 pregnancies (34.6%). Pregnancies with adverse outcomes had significantly higher UA PI and lower cerebral Doppler indices, including MCA PI (p&#x2009;=&#x2009;0.004), ACA PI (p&#x2009;=&#x2009;0.021), PCA PI (p&#x2009;=&#x2009;0.036), and CPR (p&#x2009;=&#x2009;0.002). CPR showed the highest discriminative performance (AUC&#x2009;=&#x2009;0.85; 95%CI: 0.77-0.92), followed by MCA PI (AUC&#x2009;=&#x2009;0.80), ACA PI (AUC&#x2009;=&#x2009;0.74), and PCA PI (AUC&#x2009;=&#x2009;0.70). In multivariable analysis, MCA PI, ACA PI, PCA PI, and estimated fetal weight percentile were independent predictors of adverse perinatal outcome. In late-onset FGR, Doppler abnormalities in the anterior and posterior cerebral arteries were associated with adverse perinatal outcomes. Assessment of ACA and PCA Doppler parameters may provide complementary prognostic information regarding fetal cerebral hemodynamic adaptation alongside conventional MCA and CPR evaluation.