The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

The Relationship between Middle Cerebral Artery Circulatory Disorders Detected by Doppler Ultrasound and Predic

Document Type : Original Article

Authors
Sarah Mohammadi 1
Zahra Naeiji 2
Fatemeh Lakzaee 1
Mahboubeh Barsam 1
Nayereh Rahmati 3
1 Resident, Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
10.22038/ijogi.2026.91959.6575
Abstract
Introduction: Examination of the status of the middle cerebral artery can significantly indicate the efficiency of the fetal circulatory system and the quality of blood supply to fetal tissues. This study was conducted with aim to investigate the relationship between middle cerebral artery circulatory disorders shown on Doppler ultrasound and erratic fetal heart rate during labor.
Methods: This cross-sectional study was conducted in 2022-2024 on 233 full-term (37-41 weeks) pregnant women with singletons who referred to Mahdieh Hospital, Shahid Beheshti University of Medical Sciences, Tehran for delivery. Doppler ultrasound of the middle cerebral artery was performed for all subjects, and the relationship of the findings with uncertain fetal heart rate during labor was examined. Patients were divided into two groups: the first (with regular heart rate) and the second (with irregular heart rate). Data were analyzed using SPSS statistical software (version 18) and t-test, chi-square and ANOVA tests. P<0.05 was considered significant.
Results: The mean Doppler of the middle cerebral artery in the first group was 1.40±0.31 and in the second group was 1.35±0.24, and there was no statistically significant relationship between the two groups (p=0.50). Also, the systolic to diastolic ratio of the resistance index and the maximum systolic velocity of the middle cerebral artery Doppler in the first group were higher than in the second group, but was not statistically significant (p>0.05). The Doppler of the middle cerebral artery resistance index was the same in both groups (p=0.91). In contrast, the mean umbilical artery resistance index in the second group was higher than in the first group, which was statistically significant (p=0.03).
Conclusion: Simultaneous evaluation of Doppler indices and fetal heart rate pattern can be an appropriate approach to identify fetuses at risk of adverse outcomes.
Keywords
Fetal Complications
Middle Cerebral Artery
Predictability
Term Pregnancy
Subjects
1.        Bhutta BS, Alghoula F, Berim I. Hypoxia. InStatPearls [internet] 2024 Mar 4. StatPearls Publishing.
2.        Haybar H, Shahrabi S, Rezaeeyan H, Shirzad R, Saki N. Endothelial cells: from dysfunction mechanism to pharmacological effect in cardiovascular disease. Cardiovascular Toxicology 2019; 19(1):13-22.
3.        Levine RL. Ischemia: from acidosis to oxidation. The FASEB journal 1993; 7(13):1242-6.
4.        Bobrow CS, Soothill PW. Causes and consequences of fetal acidosis. Archives of Disease in Childhood-Fetal and Neonatal Edition 1999; 80(3):F246-9.
5.        Lundgren J, Zhang H, Agardh CD, Smith ML, Evans PJ, Halliwell B, et al. Acidosis-induced ischemic brain damage: are free radicals involved?. Journal of Cerebral Blood Flow & Metabolism 1991; 11(4):587-96.
6.        Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. American journal of obstetrics and gynecology 2008; 199(6):587-95.
7.        Okereafor A, Allsop J, Counsell SJ, Fitzpatrick J, Azzopardi D, Rutherford MA, et al. Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008; 121(5):906-14.
8.        Mortezaee FT, Tabatabaiefar MA, Chaleshtori MH, Miraj S. Lack of association between ESR1 and CYP1A1 gene polymorphisms and susceptibility to uterine leiomyoma in female patients of Iranian descent. Cell Journal (Yakhteh) 2014; 16(2):225.
9.        Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology 2013; 55(6):509-19.
10.     Panda S, Singh A, Kato H, Kokhanov A. Cerebral palsy: a current perspective. NeoReviews 2024; 25(6):e350-60.
11.     Clark SL, Hankins GD. Temporal and demographic trends in cerebral palsy—fact and fiction. American journal of obstetrics and gynecology 2003; 188(3):628-33.
12.     Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane database of systematic reviews. 2013(5).
13.     Goodwin L. Intermittent auscultation of the fetal heart rate: a review of general principles. The Journal of perinatal & neonatal nursing 2000; 14(3):53-61.
14.     Albers LL. Monitoring the fetus in labor: evidence to support the methods. Journal of Midwifery & Women's Health 2001; 46(6):366-73.
15.     Sholapurkar SL. Intermittent auscultation in labor: could it be missing many pathological (late) fetal heart rate decelerations? Analytical review and rationale for improvement supported by clinical cases. Journal of clinical medicine research 2015; 7(12):919-25.
16.     Martis R, Emilia O, Nurdiati DS, Brown J. Intermittent auscultation (IA) of fetal heart rate in labour for fetal well‐being. Cochrane Database of Systematic Reviews; 2017(2).
17.     Mustafazade T, Navruzova S, Veliyeva A, Zhubanysheva K, Kachurina D, Mussabekova A, et al. Clinical markers for early diagnosis of small for gestational age births; a cross-sectional study. Immunopathologia Persa 2025; 12(1):e43918-.
18.     Devane D, Lalor JG, Daly S, McGuire W, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database of Systematic Reviews; 2012(2).
19.     Prior T, Mullins E, Bennett P, Kumar S. Prediction of fetal compromise in labor. Obstetrics & Gynecology 2014; 123(6):1263-71.
20.     Morales‐Roselló J, Khalil A, Morlando M, Bhide A, Papageorghiou A, Thilaganathan B. Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio. Ultrasound in Obstetrics & Gynecology 2015; 45(2):156-61.
21.     Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission?. American journal of obstetrics and gynecology 2015; 213(1):54-e1.
22.     Khalil AA, Morales-Rosello J, Elsaddig M, Khan N, Papageorghiou A, Bhide A, et al. The association between fetal Doppler and admission to neonatal unit at term. American journal of obstetrics and gynecology 2015; 213(1):57-e1.
23.     Golshahi F, Sahebdel B, Shirazi M, Sharbaf FR, Aliabadi HR, Taghavipour M, et al. Relationship between fetal middle cerebral artery pulsatility index and cerebroplacental ratio with adverse neonatal outcomes in low-risk pregnancy candidates for elective cesarean section: A cross-sectional study. International journal of reproductive biomedicine 2022; 20(8):663-70.
24.     Crovetto F, Baffero G, Cesano N, Rossi F, Acerboni S, De Marinis S, et al. OP31. 08: Fetal middle cerebral artery Doppler at 40 weeks' gestation in the prediction of emergency delivery for fetal distress in labour. Ultrasound in Obstetrics & Gynecology 2016; 48:156-.
25.     Pugalia S, Mhapankar S, Shetty S, Kumar S. Correlation Between Fetal Middle Cerebral Artery and Umbilical Artery Doppler Ratio at 38-40 weeks of Gestation with Fetal Distress and Adverse Perinatal Outcome. Global Journal Of Medical Students 2022; 2(2).
26.     Zhou P, Sun Y, Tan Y, An Y, Wang X, Wang L. Fetal and neonatal middle cerebral artery hemodynamic changes and significance under ultrasound detection in hypertensive disorder complicating pregnancy patients with different severities. Computational and mathematical methods in medicine 2022; 2022(1):6110228.
27.     Leung WC, Lam H, Lee CP, Lao TT. Doppler study of the umbilical and fetal middle cerebral arteries in women with gestational diabetes mellitus. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2004; 24(5):534-7.
28.     Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. Bmj 2018; 360.
29.     Paneth N. Low Apgar score is associated with cerebral palsy in children. The Journal of Pediatrics 2011; 158(5):860-1.
30.     Wang SH, Hung YL, Shen CM, Hsieh WS, Network TP. Perinatal risk factors and outcomes of pulmonary air leak in very-low-birth-weight preterm infants: a multicenter registry study in Taiwan. Pediatrics & Neonatology 2025; 66(4):375-81.
31.     Ernest E, Wainstock T, Sheiner E, Segal I, Landau D, Walfisch A. Apgar score and long-term respiratory morbidity of the offspring: a population-based cohort study with up to 18 years of follow-up. European journal of pediatrics 2019; 178(3):403-11.
32.     Wennergren M, Krantz M, Hjalmarson O, Karlsson K. Low Apgar score as a risk factor for respiratory disturbances in the newborn infant. J Perinat Med 1987; 15(2):153-60.
33.     Lie KK, Grøholt EK, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. Bmj 2010; 341.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 2
April 2026
Pages 31-39