Foetal cerebral blood redistribution in idiopathic polyhydramnios and the impact on perinatal outcomes
Creators: name: Sgayer, Inshirah
name: Haddad, Yousef
name: Francis, Yara Nakhleh
name: Tuma, Ruba
name: Lowenstein, Lior
name: Odeh, Marwan
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Space Science
subject: Medicine
subject: Cell Biology
subject: Molecular Biology
subject: Physiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Chemical Sciences not elsewhere classified
subject: Sociology
subject: FOS: Sociology
subject: Biological Sciences not elsewhere classified

description: Idiopathic polyhydramnios is associated with adverse neonatal outcome. The aim of this study was to examine the value of the middle cerebral artery pulsatility index (MCA-PI) in predicting adverse perinatal outcome in pregnancies affected by idiopathic polyhydramnios. A retrospective study was performed during 2013–2022 at a tertiary-care university affiliated hospital. The study included singleton pregnancies with idiopathic polyhydramnios. Obstetrical and perinatal outcomes were compared between women with MCA-PI &lt;10th percentile and women with MCA-P ≥ 10th percentile. A composite adverse perinatal outcome was defined as an Apgar score &lt;7 at 5 minutes, umbilical artery pH &lt;7.15, emergent caesarean delivery (CD) or operative delivery due to foetal distress, neonatal intensive care admission or foetal death. Among 45,459 pregnancies, 128 (0.3%) had idiopathic polyhydramnios; 27 exhibited MCA-PI &lt;10th percentile. Among the latter, compared to pregnancies with MCA-PI ≥10th percentile group, the rates were higher of emergent CD (25.9% vs. 7.9%, p = 0.017) and adverse perinatal outcomes (37.0% vs. 15.8%, p = 0.020). These differences persisted in a subgroup analysis of women with moderate or severe polyhydramnios. In the MCA-PI &lt;10th percentile group, the median MCA-PI and cerebroplacental ratio were lower: 0.9 vs. 1.7, <i>p</i> &lt; 0.001 and 0.7 vs. 2.1, <i>p</i> &lt; 0.001, respectively. Receiver operating characteristic curve analysis indicated a significant association of MCA-PI with emergent CD/operative delivery for foetal distress (area under curve = 0.672, p = 0.031); the sensitivity was 46.7% and specificity 82.3%. Cerebroplacental ratio values were not associated with adverse perinatal outcomes. Idiopathic polyhydramnios might be associated with foetal cerebral blood flow redistribution, potentially contributing to an increased risk of adverse neonatal outcomes. Prospective studies are required to establish the role of foetal Doppler studies in the antenatal surveillance of idiopathic polyhydramnios, and to determine whether evidence of abnormal MCA-PI serves as a reliable predictor of perinatal outcomes, potentially necessitating labour induction. Polyhydramnios is a condition in pregnancy characterized by an excessive amount of amniotic fluid, and in many cases, the cause remains unidentified, referred to as idiopathic polyhydramnios. This study aimed to determine whether changes in blood flow to the fetus’s brain, specifically in the middle cerebral artery (MCA), could predict adverse outcomes during delivery. To assess this, the researchers used Doppler ultrasound to measure the pulsatility index (PI) of the MCA, which reflects the blood flow resistance in the artery. The study compared two groups of pregnancies with idiopathic polyhydramnios—those with reduced MCA blood flow (below the 10th percentile) and those with normal blood flow. It was observed that pregnancies with reduced MCA-PI were more likely to experience complications, such as emergency cesarean deliveries due to fetal distress and the need for neonatal intensive care unit admissions. These findings suggest that altered blood flow in the fetal brain might indicate increased risks of complications during delivery. The results support the idea that monitoring MCA blood flow in pregnancies complicated by polyhydramnios could offer valuable insights for early intervention and management. However, further research is necessary to confirm whether MCA Doppler assessments can reliably predict which pregnancies are at higher risk and whether such monitoring should guide clinical decisions like early induction of labor.