Effectiveness of Doppler Indices in Predicting Adverse Perinatal Outcomes in Early and Late-Onset FGR: Systematic Review
DOI:
https://doi.org/10.65759/ah2tww57Keywords:
Fetal growth restriction, Doppler ultrasound, cerebroplacental ratio, umbilical artery, ductus venosusAbstract
Background: Doppler velocimetry guides monitoring in fetal growth restriction (FGR), and the most informative index differ by early- vs late-onset disease. We aimed to evaluate Doppler indices to predict adverse perinatal outcomes in early- and late-onset FGR. Methods: We searched online databases and screened full-text original studies linking Doppler measures with perinatal outcomes in FGR. Data were extracted on design, sample size, FGR, onset definitions, Doppler markers, outcome composites, and predictive performance, AUC, sensitivity, and specificity. Findings were analyzed qualitatively, because thresholds and outcomes varied. Results: we include nine observational studies. Common markers were UA-PI, MCA-PI, uterine artery PI, and ratios; some studies assessed composite measures. Late-onset cohorts found moderate to high discrimination for selected predictors, whereas larger cohorts showed modest performance for UCR and CPR thresholds. Abnormal UA Doppler was more sensitive than low CPR for predicting SGA, with similar specificity. Early abnormal UA Doppler identified higher stillbirth risk but had low sensitivity. Conclusion: Doppler indices aid risk grouping in FGR, but accuracy varies by onset phenotype, marker choice, and outcome definition; we need standardized thresholds and outcome sets in practice.
References
1. Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees CC. Early onset fetal growth restriction. Matern Heal Neonatol Perinatol. 2017 Dec 18;3(1):2. doi: 10.1186/s40748-016-0041-x
2. Lees CC, Romero R, Stampalija T, Dall’Asta A, DeVore GR, Prefumo F, et al. The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. Am J Obstet Gynecol. 2022 Mar;226(3):366–78. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002937821025862
3. Vollgraff Heidweiller‐Schreurs CA, De Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PMM, Mol BWJ, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2018 Mar 5;51(3):313–22. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.18809
4. Yang Z, Lv W, Zhao B, Yao J, Yang Y, Yin Z. Uteroplacental–Cerebral Ratio: A Doppler Parameter for Prognostic Prediction of Late-Onset Fetal Growth Restriction: Single Center Prospective Cohort Study. J Clin Med. 2022 Dec 29;12(1):275.
5. Dall’Asta A, Stampalija T, Mecacci F, Minopoli M, Schera GBL, Cagninelli G, et al. Ultrasound prediction of adverse perinatal outcome at diagnosis of late‐onset fetal growth restriction. Ultrasound Obstet Gynecol. 2022 Mar 3;59(3):342–9. doi: 10.1002/uog.23714
6. Wolf H, Stampalija T, Lees CC. Fetal cerebral blood‐flow redistribution: analysis of Doppler reference charts and association of different thresholds with adverse perinatal outcome. Ultrasound Obstet Gynecol. 2021 Nov;58(5):705–15. doi: 10.1002/uog.23615
7. Leavitt K, Odibo L, Nwabuobi C, Tuuli MG, Odibo A. The value of introducing cerebroplacental ratio (CPR) versus umbilical artery (UA) Doppler alone for the prediction of neonatal small for gestational age (SGA) and short-term adverse outcomes. J Matern Neonatal Med. 2021 May 19;34(10):1565–9. doi: 10.1080/14767058.2019.1640206
8. Yılmaz C, Melekoğlu R, Özdemir H, Yaşar Ş. The role of different Doppler parameters in predicting adverse neonatal outcomes in fetuses with late-onset fetal growth restriction. J Turkish Soc Obstet Gynecol. 2023 Jun 1;20(2):86–96.
9. Karabay G. Relationship Between Adverse Neonatal Outcomes and Diastolic Deceleration Area on Fetal MCA Doppler in Patients with Late Fetal Growth Restriction. SiSli Etfal Hastan Tip Bul / Med Bull Sisli Hosp. 2025;119–26.
10. Adedo AA, Arogundade RA, Okunowo AA, Idowu BM, Oduola-Owoo LT. Comparative Study of the Umbilical Artery Doppler Indices of Healthy and Growth-Restricted Foetuses in Lagos. J West African Coll Surg. 2022 Apr;12(2):63–9.
11. Lewkowitz AK, Tuuli MG, Cahill AG, Macones GA, Dicke JM. Perinatal outcomes after intrauterine growth restriction and umbilical artery Doppler pulsatility index of less than the fifth percentile. J Matern Neonatal Med. 2021 Mar 4;34(5):677–82. doi: 10.1080/14767058.2019.1612871
12. Hertting E, Herling L, Lindqvist PG, Wiberg-Itzel E. Antenatal identification of early- and late-onset fetal growth restriction and the possible impact of the introduction of cerebroplacental ratio: Effect on perinatal and childhood outcome. Shah NM, editor. PLoS One. 2025 Jun 18;20(6):e0325906. doi: 10.1371/journal.pone.0325906
13. Elmes C, Phillips R. Systematic review evaluating the efficacy of the cerebroplacental ratio (CPR) in saving babies lives. Ultrasound. 2022 Aug 19;30(3):184–93. doi: 10.1177/1742271X211048213
14. Cancarevic Djajic B, Draganovic D, Milic-Radic T, Sobot S, Popovic B, Milidragovic J, et al. Predictive Value of Venous Ductus Doppler in Perinatal Outcomes in Fetal Growth Restriction. Cureus. 2025 Sep 21.
15. Packet B, Page AS, Bosteels J, Richter J. Peripartum fetal Doppler sonography and perinatal outcome: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2025 May 8;25(1):545. doi: 10.1186/s12884-025-07586-0
