Analysis of the Correlation/Agreement of Maternal-fetal Doppler Parameters in Normal and Growth-Restricted Fetuses

Pinsuti, Ederlei Munhoz; Bruns, Rafael Frederico; Kulak Júnior, Jaime; Carvalho, Newton Sérgio; Nascimento, Dênis José; Zamarian, Ana Cristina Perez; Araújo Júnior, Edward

doi:10.1055/s-0041-1741453

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Original Article • Rev. Bras. Ginecol. Obstet. 44 (02) • Feb 2022 • https://doi.org/10.1055/s-0041-1741453 copy

Analysis of the Correlation/Agreement of Maternal-fetal Doppler Parameters in Normal and Growth-Restricted Fetuses

Análise da correlação/concordância dos parâmetros Doppler materno-fetal em fetos normais e com restrição do crescimento

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the degree of correlation/agreement of maternal-fetal Doppler parameters between normal and growth-restricted fetuses (fetal growth restriction [FGR]).

Methods

The present observational and retrospective study included 274 singleton pregnancies. The following maternal-fetal Doppler parameters were assessed: uterine artery (UAt), umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), and umbilical-cerebral ratio (U/C). The assessment of FGR was based on the Figueiras and Gratacós9 criteria. Spearman correlation coefficients were estimated to assess the correlation between resistance (RI) and pulsatility (PI) indices of Doppler parameters. The agreement between two Doppler parameters was assessed by the Kappa coefficient.

Results

In total, 502 Doppler examinations were included, and FGR was observed in 19 out of 274 fetuses. A strong correlation was observed between RI and PI of UAt, UA, and MCA in all of the samples (p<0.001). Of the 502 Doppler examinations, there was agreement between U/C and CPR percentiles for 480 (95.6%) and disagreement for 22 (4.4%), with Kappa coefficient of 0.26, thereby corresponding to weak agreement. Of the 68 cases with estimated fetal weight ≤ 9th percentile (small for gestational age [SGA]), there was agreement between U/C>1.0 and CPR<5th percentile in 61 (88.4%) and disagreement in 7 (5.8%) with Kappa coefficient of 0.49, thereby corresponding to moderate agreement.

Conclusion

Strong correlation was observed among RI and PI UAt, UA, and MCA Doppler examinations in the present study; however, weak agreement was observed between U/C and CPR in the normal and FGR fetuses. In SGA, U/C and CPR demonstrated moderate agreement.

Keywords:
fetal growth restriction; doppler; cerebroplacental ratio; agreement; correlation

Doppler parameter	GA (weeks)	n	Mean	Median	Minimum	Maximum	Standard deviation
RI Right UAt	≤ 28	51	0.51	0.49	0.22	1.71	0.20
	28.1–32	112	0.49	0.48	0.23	0.85	0.10
	32.1–36	178	0.47	0.46	0.27	0.81	0.10
	> 36	161	0.45	0.44	0.08	0.77	0.10
PI Right UAt	≤ 28	51	0.77	0.73	0.28	2.17	0.30
	28.1–32	112	0.77	0.71	0.27	2.37	0.31
	32.1–36	178	0.71	0.67	0.34	1.71	0.24
	> 36	161	0.67	0.63	0.32	1.77	0.20
RI Left UAt	≤ 28	51	0.52	0.52	0.35	0.89	0.10
	28.1–32	112	0.49	0.48	0.30	0.74	0.09
	32.1–36	178	0.47	0.47	0.17	0.76	0.09
	> 36	161	0,45	0.44	0.24	0.78	0.09
PI Left UAt	≤ 28	51	0.80	0.77	0.45	1.65	0.22
	28.1–32	112	0.75	0.70	0.36	1.79	0.23
	32.1–36	178	0.71	0.68	0.24	1.90	0.23
	> 36	161	0.67	0.61	0.30	1.70	0.21
PI UA	≤ 28	51	1.14	1.14	0.57	1.89	0.20
	28.1–32	112	1.01	1.02	0.61	1.67	0.19
	32.1–36	178	0.90	0.89	0.55	1.48	0.17
	> 36	161	0.85	0.84	0.45	1.22	0.15
Percentile UA	≤ 28	51	45.69	46.00	3.00	99.00	20.41
	28.1–32	112	46.16	46.00	5.00	98.00	20.34
	32.1–36	178	43.92	41.00	8.00	96.00	20.06
	> 36	161	41.82	40.00	6.00	84.00	17.85
RI UA	≤28	51	0.70	0.70	0.45	0.88	0.07
	28.1–32	112	0.64	0.65	0.45	0.83	0.07
	32.1–36	178	0.59	0.60	0.43	0.79	0.07
	> 36	161	0.57	0.57	0.38	0.73	0.06
PI MCA	≤28	51	2.21	2.22	1.43	3.09	0.45
	28.1–32	112	2.17	2.13	0.86	3.65	0.51
	32.1–36	178	1.93	1.88	0.73	4.30	0.47
	>36	161	1,60	1.51	0.84	2.60	0.33
RI MCA	≤ 28	51	0.89	0.88	0.74	1.00	0.08
	28.1–32	112	0.88	0.87	0.57	1.06	0.08
	32.1–36	178	0.83	0.83	0.62	1.04	0.07
	> 36	161	0.77	0.76	0.55	1.00	0.07
CPR	≤ 28	51	1.98	1.93	1.21	3.45	0.50
	28.1–32	112	2.20	2.15	0.51	4.15	0.60
	32.1–36	178	2.20	2.16	0.69	3.98	0.58
	> 36	161	1.94	1.87	1.15	5.04	0.56
Percentile CPR	≤28	51	50.37	56.00	4.00	99.00	30.98
	28.1–32	112	53.04	51.50	1.00	99.00	31.08
	32.1–36	178	52.86	53.00	1.00	99.00	30.04
	> 36	161	43.07	38.00	3.00	99.00	30.07
U/C	≤ 28	51	0.79	0.80	0.58	0.99	0.10
	28.1–32	112	0.74	0.73	0.45	1.46	0.11
	32.1–36	178	0.72	0.71	0.51	1.08	0.10
	> 36	161	0.74	0.75	0.46	0.95	0.10
Percentile MCA	≤ 28	51	59.47	67.00	4.00	99.00	31.72
	28.1–32	112	56.79	60.00	1.00	99.00	32.66
	32.1–36	178	52.30	53.50	1.00	99.00	30.11
	> 36	161	48.09	46.00	1.00	99.00	29.16

Variables	n	Spearman's correlation coefficient	p-value
RI Right UAt versus PI Right UAt	502	0.97	< 0.001
RI Left UAt versus PI Left UAt	502	0.97	< 0.001
RI UA versus PI UA	502	0.97	< 0.001
RI MCA versus PI MCA	502	0.96	< 0.001

Percentile CPR	U/C		Total
Percentile CPR	Normal (≤ 1)	Altered (> 1)	Total
Normal (≥ 5^th)	476	0	476
	94.8%	0.0%	94.8%
Altered (< 5^th)	22	4	26
	4.4%	0.8%	5.2%
Total	498	4	502

CPR (< 5^th)	U/C (> 1.0)		Total
CPR (< 5^th)	No	Yes	Total
No	57	0	52
No	89.1%	0.0%	52
Yes	7	4	16
Yes	10.9%	100%	16
Total	64	4	68

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[1] Address for correspondence
Edward Araujo Júnior, PhD, Rua Botucatu, 740, 04023-062, Vila Clementino, São Paulo, SP, Brazil (e-mail: araujojred@terra.com.br).