Fetal Middle Cerebral Artery Systolic-Diastolic Ratio at 12-41 weeks of gestation and clinical application in a Tertiary Hospital in Jos, North Central Nigeria
Article Sidebar
Main Article Content
Abstract
Background: Studies on fetal Middle Cerebral Artery (MCA) Systolic-Diastolic ratio reflecting resistance to blood flow in the MCA and its changes over gestation in response to fetal distress are well documented in literatures, however, there is paucity of local data in this regard. The study aimed to determine normal ranges for fetal MCA Doppler S/D ratio at 12 to 41 weeks of gestation and their pattern in normal pregnancies at Jos University Teaching Hospital, Jos, Nigeria.
Methods: A cross-sectional, convenient sampling was used to recruit 456 pregnant women who were non-smokers and had no clinical history of autoimmune conditions. They were scanned using ultrasound and Doppler to establish fetal gestational age (GA), Doppler indices and also to determine the suitability of subjects for inclusion into the study. Descriptive statistics was used to determine mean waveform values of percentile curves for S/D ratio. Pearson’s correlation determined the relationship between the variables, p< 0.05.
Results: The mean (±SD) age of subjects was 27.93±5.17 years. The S/D ratio was demonstrated as follows: 3.47±0.43 at 12 weeks, 3.95±1.07 at 28 weeks and 2.19±0.21 at 40 weeks. The relationship between S/D ratio and fetal GA yielded a regression curve equation: S/D ratio=4.591GA-0.036
Conclusion: This study established percentile curves and normative values of the fetal MCA S/D ratio of fetuses aged between the 12th to 41st weeks of gestation. A regression curve equation was established which could serve as prediction model together with the normative values, help to discriminate between a normal fetal situation and disease.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
How to Cite
References
1.Nigeria Infant Mortality Rate. Macrotrends LLC, Historic Data: 1950-2025.
2.United Nation Inter-agency Group for Child Mortality Estimation, under-five mortality. UN; 2025
3.Manning FA. Fetal Medicine: Principles and Practice. Appleton & Lange, Norwalk, CT; 1995.
4.Burton GJ, Fowden AL, Thornburg KL. Placental origins of chronic disease. Physiol Rev. 2016; 96:1509-65.
5.Jornayvaz FR, Vollenweider P, Bochud M, Mooser V, Waeber G, Marques-Vidal P. Low birth weight leads to obesity, diabetes and increased leptin levels in adults: the CoLaus study. Cardiovasc Diabetol. 2016; 15:73.
6.Woo JS,Liang ST, Lo RL, Chan FY. Middle cerebral artery Doppler flow velocity waveforms. Obstet Gynecol. 1987; 70(4):613-6.
7.Maulik D.F. Doppler velocimetry for fetal surveillance: Adverse perinatal outcome and fetal hypoxia. Doppler ultrasound in obstetrics. SpringerVerlag Berlin Heideberg. 2005; 363-372.
8.Vyas S, Cambell S, Bower S, Nicolaides K. H. Maternal abdominal pressure alters fetal cerebral blood flow. British Journal of Obstetrics.1990; 97: 740-2.
9.Gaary K, Langche Z. In improving forecast of state failure: World politics.2001; 53(4):623-658
10.Bilardo C, M, Cambell S. Mean blood velocities and flow impedance in the fetal descending thoracic aortic and common carotid artery in normal pregnancy. Early human development. 1988; 18:213-21
11.Liley AW. Liquor amnil analysis in the management of pregnancy complicated by rhesus sensitization. Am J. Obstet. Gynecol. 1961; 82:1359-70
12.Bahlmann F, Reinhard L, Krummeneaur F, Neubert S, Macchiella D, WellerS. Blood flow waveforms of the fetal middle cerebral artery in a normal population:reference values from 18 weeks to 42 weeks of gestation. Journal perinatal medicine. 2002; 30:490-501
13.Gagnon R, Van den Hof M. Diagnostic Imaging Committee, Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. The use of fetal Doppler in obstetrics. J Obstet Gynaecol Can. 2003; 25(7):601-14
14.Ertan K, Hendrik HJ, Tanriverdi HA, et al. Doppler sonography in obstetrics. Donald school J Ultrasound Obstet Gynecol. 2013;7(2):128-148
15.Favre R, Schonenberger R, I rael Nisand, Lorenz U. Standard Curves of Cerebral Doppler Flow Velocity Waveforms and Predictive Values of Intrauterine Growth Retardation and Fetal Acidosis. Fetal Diagn Ther. 1991;6(3-4)
16.Tarzamni M K, Narima N, Sobhani N, Eshraghi N, Tarzamni M, Taalebi Y. Nomograms of Iranian fetal middle cerebral artery waveforms and uniformity of their pattern with other populations’ nomograms, BMC pregnancy and childbirth. 2008; 8:50
17.Mari G, Haif F, KrugeEngr M, Cosmi E, Santolayaforgas J, Treadwell M C. Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol. 2007;29:310-316.
18.Imdad A, Yakoob MY, Siddiqul S, Bhutta ZA. Screening and triage of intrauterine growth restriction (IUGR) in general population and highrisk pregnancies: a systematic review with focus on reduction of IUGR related stillbirths. BMC Public Health. 2011; 13:11.
19.Meyberg R, Ertan AK, Tossounidis I, Friedrict M, Schmidt W. Rerence ranges and standard percentile –curves for the Doppler indices RI and /D ratio of the fetal middle cerebral artery. Color Doppler measurements in a perinatal centre. Clin Exp Obstet Gynecol.2000;27(2):106-8
20.Moore KL, Dalley AR. Clinically oriented anatomy,4th Ed., Lippincott Williams and Wilkins, Toronto. Copyright 1999. ISBN O-683-06141-0
21.Seffa JD,Swarray-Dean A. Fetal middle cerebral artery Doppler indices and clinical application at Korle Bu Teaching Hospital, Accra. Ghana. Int J Gynaecol Obstet. 2016;134(2): 1359.
22.C Ebbing, S Rasmussen, T Kiserud. Middle cerebral artery blood flow velocities and Pulsatility index and the cerebroplacental Pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol. 2007;30 :287-296
23.Puerto B,Coll O, Gomez O, Palacio M, Lopez M, Figuera F, Martinez JM, Rio del M. Reference ranges for Doppler parameters of fetal aortic isthmus during the second half of pregnancy. Ultrasound in obstetrics and Gynaecology. 2006; volume 28, issue 1: 71-78
24.Royston P, Wright EM. How to construct “normal ranges” for fetal variables. Ultrasound Obstet Gynecol. 1998; 11:30-38
25.Kachewar S G, Siddappa G G. the Foetal ‘Mind’ as a reflection of its Inner Self: Evidence from Colour Doppler Ultrasoun of Foetal MCA. Mens Sana Monogr.2012;10(1): 98-108