Invest Clin 66(1): 16 - 25, 2025 https://doi.org/10.54817/IC.v66n1a02

Corresponding author: Dongdong Zhong. Department of Obstetrics, The People’s Hospital of Pingyang County,

Wenzhou 325400, Zhejiang Province, China. E-mail: zhongddphpc@puxin-edu.cn

Values of hemodynamic changes

of fetal vessels evaluated by color

Doppler ultrasound for fetuses with

growth restriction.

Yangyang Chen and Dongdong Zhong

Department of Obstetrics, The People’s Hospital of Pingyang, Zhejiang Province,

China.

Key words: color; Doppler ultrasound; fetal growth; growth restriction; restriction.

Abstract. We aimed to explore the values of hemodynamic changes of fetal

vessels evaluated by color Doppler ultrasound (CDUS) for fetal growth restric-

tion (FGR). A retrospective analysis was performed on clinical data of 75 preg-

nant women who received prenatal examination from January 2021 to August

2023 and whose fetuses were diagnosed with FGR (FGR group) and 75 preg-

nant women whose fetuses were healthy in the same period and were consid-

ered as the healthy group. CDUS was performed on the fetuses. The values of

indicators of umbilical artery, middle cerebral artery and aortic arch isthmus

for assessing pregnancy outcomes were investigated. The FGR group had signif-

icantly lowered arterial resistance index (RI), blood flow pulsatility index (PI),

and systolic and diastolic velocity (S/D) levels of the middle cerebral artery and

peak systolic velocity (PSV)/end-systolic reflux velocity (ESRV) level of aortic

arch isthmus but significantly elevated RI, PI, and S/D levels of umbilical artery

in comparison with those of the healthy group (p<0.05). The areas under the

receiver operating characteristic curves (AUCs) of RI, PI, and S/D of the umbili-

cal artery in diagnosing FGR were 0.893, 0.893 and 0.900, respectively, AUCs

of RI, PI, and S/D of the middle cerebral artery were 0.812, 0.874 and 0.910,

respectively, and AUC of PSV/ESRV was 0.857 (p<0.05). The incidence rate of

severe hypoxia was significantly higher in the fetuses with a more significant

RI value of the middle cerebral artery and a larger PSV/ESRV value than those

with a smaller RI value of the middle cerebral artery and a smaller PSV/ESRV

value (p<0.05). The changes in umbilical artery RI, middle cerebral artery RI,

and PSV/ESRV were unrelated to fetal survival rate (p>0.05). Fetal umbilical

artery, middle cerebral artery and aortic arch isthmus parameters detected

through CDUS are all sensitive indices for assessing FGR.

Evaluation of fetal growth restriction by color Doppler ultrasound 17

Vol. 66(1): 16 - 25, 2025

Valores de los cambios hemodinámicos de los vasos fetales

evaluados mediante ecografía Doppler a color en fetos

con restricción del crecimiento.

Invest Clin 2025; 66 (1): 16 – 25

Palabras clave: color; ecografía Doppler; crecimiento fetal; parámetro; restricción

de crecimiento, flujo sanguíneo arterial.

Resumen. Nuestro objetivo fue explorar los valores de los cambios hemodiná-

micos de los vasos fetales evaluados mediante ecografía Doppler a color (CDUS)

en la restricción del crecimiento fetal (FGR). Se realizó un análisis retrospectivo

de los datos clínicos de 75 mujeres embarazadas que recibieron un examen pre-

natal desde enero de 2021 hasta agosto de 2023 y cuyos fetos fueron diagnostica-

dos con FGR (grupo FGR) y 75 mujeres embarazadas cuyos fetos estaban sanos

en el mismo período y se consideraron como el grupo sano. Se realizó CDUS en

los fetos. Se investigaron los valores de los indicadores de la arteria umbilical, la

arteria cerebral media y el istmo del arco aórtico para evaluar los resultados del

embarazo. El grupo FGR tuvo un índice de resistencia arterial (IR), un índice de

pulsatilidad del flujo sanguíneo (IP) y niveles de velocidad sistólica y diastólica

(S/D) significativamente reducidos de la arteria cerebral media y un nivel de velo-

cidad sistólica máxima (PSV)/velocidad de reflujo telesistólico (ESRV) del istmo

del arco aórtico, pero niveles significativamente elevados de IR, IP y S/D de la ar-

teria umbilical en comparación con los del grupo sano (p<0,05). Las áreas bajo

las curvas de características operativas del receptor (AUC) de RI, PI y S/D de la

arteria umbilical en el diagnóstico de FGR fueron 0,893, 0,893 y 0,900, respecti-

vamente, las AUC de RI, PI y S/D de la arteria cerebral media fueron 0,812, 0,874

y 0,910, respectivamente, y el AUC de PSV/ESRV fue 0,857 (p<0,05). La tasa

de incidencia de hipoxia grave fue significativamente mayor en los fetos con un

valor de RI más significativo de la arteria cerebral media y un valor de PSV/ESRV

mayor que aquellos con un valor de RI menor de la arteria cerebral media y un

valor de PSV/ESRV menor (p<0,05). Los cambios en el RI de la arteria umbilical,

el RI de la arteria cerebral media y el PSV/ESRV no se relacionaron con la tasa

de supervivencia fetal (p>0,05). Los parámetros de la arteria umbilical fetal, la

arteria cerebral media y el istmo del arco aórtico detectados mediante ecografía

endoscópica son todos índices sensibles para evaluar la RCF.

Received: 09-03-2024 Accepted: 10-02-2025

INTRODUCTION

Fetal growth restriction (FGR), a preg-

nancy complication, refers to the inability

of fetuses to achieve their genetic growth

potential, which has such characteristics

as pathological lag of intrauterine growth

rate in an intrauterine growth curve. FGR is

also one of the common perinatal complica-

tions, accounting for about 30% of perinatal

deaths, and is detected in 50% of perinatal

infants with intrauterine hypoxia during de-

18 Chen and Zhong

Investigación Clínica 66(1): 2025

livery, which is the second leading cause of

perinatal deaths 1,2. FGR has an association

with various adverse perinatal outcomes,

such as stillbirth, neonatal death, and neo-

natal diseases (intraventricular hemorrhage,

neonatal hyperbilirubinemia, and hypoglyce-

mia, among others.), probably having nega-

tive impacts on the neurobehavioral develop-

ment of affected children in the long term

and increasing the risk of such diseases as

obesity, diabetes, and cardiovascular and

cerebrovascular diseases in such children.

The pathogenesis of FGR remains unclear,

but previous studies have manifested that

maternal nutrition, placental transfer, fetal

inheritance and other relevant factors are

implicated in the development of FGR. How-

ever, given that it is hard to diagnose FGR in

the first trimester of pregnancy, FGR is usu-

ally diagnosed after delivery or in late ges-

tation, which further highlights the impor-

tance of accurate ultrasound examination

during the first trimester of pregnancy to

assess fetal growth indicators dynamically.

CDUS is a common imaging examination ap-

proach in clinical practice, characterized by

good safety, non-invasion, simple operation

and free-radiation. At 18-22 weeks of preg-

nancy, most morphological and structural

abnormalities of fetuses can be screened out

through ultrasound. As one of the crucial pa-

rameters in human physiological evaluation,

arterial blood flow can illustrate the benefits

of fetal metabolism, and blood flow velocity

distribution is of great significance in clini-

cal measurement 3. A study also denoted a

close relationship between the pathologi-

cal change of FGR and abnormal changes

in uterine-placental-fetal blood circulation.4

For this reason, early assessment of blood

flow changes in the umbilical artery, middle

cerebral artery and fetal heart is conducive

to early diagnosis and early intervention of

FGR, which is significant for improving fetal

prognosis.

In this study, 75 pregnant women who

received prenatal examination and whose fe-

tuses were diagnosed with FGR in our hospi-

tal from January 2021 to August 2023 were

enrolled as subjects to analyze the value of

relevant intraabdominal fetal parameters de-

tected by CDUS in assessing FGR.

PATIENTS AND METHODS

General data

Seventy-five pregnant women with FGR

fetuses receiving prenatal examinations in

our hospital from January 2021 to August

2023 were selected as observation subjects

(FGR group). The inclusion criteria were

set as follows: 1) Pregnant women whose fe-

tuses met the diagnostic criteria for FGR,5

2) those who were singleton, naturally con-

ceived and in the third trimester of pregnan-

cy, 3) those whose fetuses had no response

to fetal heart monitoring, 4) those with de-

creased fetal movement, 5) those who were

healthy in the past, without history of ge-

netic diseases, and 6) those with complete

clinical data and no data loss. The exclusion

criteria involved 1) pregnant women whose

fetuses had structural malformations and

chromosome abnormalities before delivery

based on ultrasound examination, 2) those

whose fetuses were complicated by severe

congenital diseases, 3) those whose fetus-

es suffered from endogenous homologous

FGR induced by fetal chromosomal abnor-

malities, 4) those with abnormities or spiral

edema in umbilical cord insertion point, or

single umbilical artery, 5) those complicat-

ed by prenatal complications or comorbidi-

ties, 6) those with placental morphological

changes, including choriocarcinoma or oth-

er lesions, or 7) those with nervous system

or mental disease. Meanwhile, 75 pregnant

women with healthy fetuses undergoing

prenatal examination in our hospital in the

same period were selected as the healthy

group. Pregnant women in the FGR group

(n=75) were aged 22-35 years old, with an

average of (28.85±5.85) years old, and had a

gestational age of 33-43 weeks, with a mean

of (37.45±4.15) weeks. In terms of parity,

there were 46 primiparas and 29 multipa-

Evaluation of fetal growth restriction by color Doppler ultrasound 19

Vol. 66(1): 16 - 25, 2025

ras. In the healthy group (n=75), pregnant

women were aged 23-35 years old, with an

average of 28.45±5.85 years old, and had a

gestational age of 35-42 weeks, with a mean

of 37.85±6.18 weeks. As to parity, there

were 42 primiparas and 33 multiparas. No

statistically significant differences between

the two groups were found in age, parity and

gestational age (p>0.05). This study was

conducted with approval from the hospital’s

Ethics Committee.

Examination methods

Routine prenatal ultrasound was mea-

sured using a real-time ultrasound imager

with a linear or convex array probe (abdomi-

nal probe frequency of 3.0-3.5 MHz, with

5.0 MHz for thin pregnant women) as fol-

lows. After exposing the abdomen of preg-

nant women, couplant was smeared on the

examination area, and the probe was placed

on the area to observe whether there was

any abnormality in fetal position, placental

position and uterine appendages. Besides,

a series of inspections were carried out on

the fetuses from head to toe, and biologi-

cal measurements were made on various

standard cross sections, including biparietal

diameter, head circumference, abdominal

circumference, and femur length. In addi-

tion, the gestational age was predicted, fetal

weight was estimated, and fetal position and

fetal number were judged. Additionally, am-

niotic fluid and the position and maturity of

the placenta were observed, and the depth

of amniotic fluid and the thickness and area

of the placenta were measured. Moreover,

observations were made on physiological

phenomena such as the fetal heart, fetal

movement, and fetal swallowing. In our hos-

pital, suspected FGR would be determined if

the fetal weight assessed by ultrasound was

less than the 10th percentile of the average

weight of normal fetuses of the same gesta-

tional age or two standard deviations below

the average weight.

CDUS was conducted with the DC-

35Pro diagnostic system (Mindray Medical

Equipment Co., Ltd., China). In brief, preg-

nant women were guided to lie in the supine

position, and the fetal weight and head cir-

cumference were routinely measured. Then,

the probe was placed vertically in the lower

abdomen and tilted to one side to find and

display the external iliac artery by the para-

sagittal section. Next, CDUS was employed

to identify the uterine artery crossing the

external iliac artery. Thereafter, consider-

ing that the uterine artery extends along

one side of the uterus to the fundus of the

uterus, the scanning direction of the probe

was adjusted so that the main uterine artery

was parallel to the sound beam as much as

possible. Next, the spectrum Doppler sam-

pling gate was placed on the main uterine

artery 1 cm below the intersection point for

measurement. After that, the contralateral

uterine artery was measured in the same

way. Thereafter, the middle cerebral artery

was examined as follows. At the standard bi-

parietal diameter section (the brain midline

was perpendicular to the sound beam as far

as possible), the probe was moved in parallel

to the fetal skull base until a pair of great

wings of sphenoid bone appeared between

the anterior cranial fossa and the middle cra-

nial fossa. The middle cerebral artery starts

from the left and right sides of the middle

part of the arterial ring, goes to both sides

of the brain and slightly deviates to the fore-

head. The sampling volume was set to 2-3

mm, the probe was placed at the point 3-5

mm away from the starting point of the Wil-

lis arterial ring, and the Doppler angle was

adjusted as close as possible to 0° (not more

than 30°), and more than three continuous

and stable pulse Doppler waveforms were ob-

tained. Finally, the arterial resistance index

(RI), blood flow pulsatility index (PI), and

systolic/diastolic velocity (S/D) levels of the

middle cerebral artery were measured.

Afterwards, the measurement of the

umbilical artery was performed. In brief, the

middle part of the umbilical cord floating in

amniotic fluid was selected for examination,

and the angle between the Doppler sound

20 Chen and Zhong

Investigación Clínica 66(1): 2025

beam and umbilical blood vessel should be

less than 30° to obtain the Doppler spec-

trum of the umbilical artery. After at least

three continuous and stable waveforms ap-

peared, the image was frozen to measure

the RI, PI, and S/D levels. Afterwards, the

three-vessel and trachea section of the fetal

heart was found to measure the peak systolic

velocity (PSV) and end-systolic reflux veloc-

ity (ESRV) levels of aortic arch isthmus, fol-

lowed by calculation of PSV/ESRV.

Observation of indicators

The changes in RI, PI, and S/D levels

of the fetal middle cerebral artery and um-

bilical artery and the PSV/ESRV level of fetal

aortic arch isthmus were compared between

the two groups.

Pregnancy outcomes were assessed. In

brief, pregnancy outcomes were observed,

and abnormal pregnancy outcomes, namely

severe hypoxia (Apgar score ≤3 points after

birth, stillbirth, neonatal death, and pres-

ence of hypoxic complications including ce-

rebral palsy) and mild hypoxia (3 points <

Apgar score ≤7 points, small for gestational

age, relieving of hypoxia symptoms after

birth, and absence of complications), were

recorded.

Statistical analysis

The SPSS 20.0 software was employed for

statistical analysis. Measurement data were ex-

pressed by ( ± SD) and subjected to the t-test.

Count data were expressed by % and subjected

to the χ2 test. The receiver operating charac-

teristics (ROC) curves were plotted to assess

the diagnostic value of ultrasound parameters

in FGR, p<0.05 suggested that the difference

was statistically significant.

RESULTS

Middle cerebral artery parameters

The RI, PI, and S/D levels of the middle

cerebral artery were obviously lower in the

FGR group than those in the healthy group

(p<0.05) (Table 1).

Table 1

Middle cerebral artery parameters.

Group n Middle cerebral artery

RI PI S/D

Healthy 75 0.72±0.16 1.60±0.37 4.56±0.59

FGR 75 0.51±0.12 1.33±0.41 3.26±0.57

t9.093 4.234 13.724

p <0.001 <0.001 <0.001

Measurement data were expressed by ( ± SD) and

subjected to the t-test. FGR: Fetal growth restriction;

PI: pulsatility index; RI: resistance index; S/D: systo-

lic/diastolic velocity.

Umbilical artery indicators

The RI, PI, and S/D levels of umbili-

cal artery were significantly higher in the

FGR group than those in the healthy group

(p<0.05) (Table 2).

Table 2

Umbilical artery parameters.

Group n Umbilical artery

RI PI S/D

Health 75 0.56±0.12 0.75±0.16 2.01±0.34

FGR 75 0.87±0.24 1.19±0.48 2.89±0.36

t10.005 7.531 15.391

p <0.001 <0.001 <0.001

Measurement data were expressed by ( ± SD) and

subjected to the t-test. FGR: Fetal growth restriction;

PI: pulsatility index; RI: resistance index; S/D: systo-

lic/diastolic velocity.

Aortic arch isthmus indicators

The PSV/ESRV level of the aortic arch

isthmus was markedly lower in the FGR group

than in the healthy group [(2.86±0.62) vs.

(3.85±0.78)] (t=8.605, p<0.05).

Diagnostic value of umbilical artery,

middle cerebral artery and aortic arch

isthmus indicators in FGR

As shown in ROC curves, the area under

the ROC curves (AUCs) of RI, PI, and S/D

of the umbilical artery in diagnosing FGR

were 0.893, 0.893 and 0.900, respectively

(p<0.05). The AUCs of RI, PI, and S/D of

Evaluation of fetal growth restriction by color Doppler ultrasound 21

Vol. 66(1): 16 - 25, 2025

middle cerebral artery in diagnosing FGR

were 0.812, 0.874 and 0.910, respectively

(p<0.05). The AUC of PSV/ESRV of aortic

arch isthmus in diagnosing FGR was 0.857

(p<0.05) (Table 3 and Fig. 1).

Evaluation of pregnancy outcomes based

on umbilical artery, middle cerebral artery

and aortic arch isthmus indicators

Combined with the ability to assess

pregnancy outcomes by simply comparing

blood flow parameters in clinical practice,

ROC curves were adopted for the analysis of

pregnancy outcomes based on the RI values

of the umbilical artery and middle cerebral

artery and the cutoff value of PSV/ESRV. It

was found that the incidence rate of severe

hypoxia was higher in fetuses with a more

significant RI value of the middle cerebral

artery and a larger PSV/ESRV value than

those with a smaller RI value of the middle

cerebral artery and a smaller PSV/ESRV val-

ue (p<0.05) (Table 4).

Table 3

Diagnostic value of umbilical artery, middle cerebral artery and aortic arch isthmus indicators in FGR.

Indicator Area

under

the curve

95%

confidence

interval

p Sensitivity Specificity Cut-off Youden

index

Umbilical

artery

RI 0.893 0.839~0.946 <0.001 76.00 86.00 0.66 0.720

PI 0.893 0.843~0.942 <0.001 93.33 70.67 1.02 0.640

S/D 0.900 0.850~0.950 <0.001 86.67 81.33 2.76 0.680

Middle

cerebral

artery

RI 0.812 0.735~0.890 <0.001 76.00 86.67 0.69 0.627

PI 0.874 0.815~0.933 <0.001 74.67 88.00 1.38 0.627

S/D 0.910 0.857~0.963 <0.001 84.00 89.33 3.38 0.733

Aortic arch

isthmus

PSV/ESRV 0.857 0.797~0.917 <0.001 84.00 73.33 3.36 0.573

ESRV: End systolic reflux velocity; PI: pulsatility index; PSV: peak systolic velocity; RI: resistance index; S/D: sys-

tolic/diastolic velocity.

Fig. 1. ROC curves of the umbilical artery, middle cerebral artery and aortic arch isthmus are indicators of FGR.

A: Diagnostic value of umbilical artery in FGR. B: Diagnostic value of middle cerebral artery in FGR. C: Diagnostic

value of aortic arch isthmus in FGR. AUC: Area under the curve; FGR: fetal growth restriction; PI: pulsatility index;

ROC: receiver operator characteristic; RI: resistance index; S/D: systolic/diastolic velocity.

22 Chen and Zhong

Investigación Clínica 66(1): 2025

Evaluation of fetal survival rate based on

umbilical artery, middle cerebral artery

and aortic arch isthmus indicators

The fetal survival rates were further

evaluated based on the umbilical artery,

middle cerebral artery, and aortic arch isth-

mus indicators. The changes in umbilical ar-

tery RI, middle cerebral artery RI, and PSV/

ESRV were not related to fetal survival rate

(p>0.05) (Table 5).

DISCUSSION

As one of the common perinatal com-

plications, FGR is closely related to placen-

tal dysfunction and decreased fetal reserve

capacity, leading to high perinatal fetal mor-

tality and a high incidence rate of long-term

complications 6. Therefore, early screening

of FGR and early intervention are significant

for improving the prognosis of fetuses with

FGR.

CDUS has no significant effect on fe-

tal growth and development due to nonin-

vasive and radiation-free operation, and it

can be used to evaluate the blood perfusion

of the fetal-placental circulation by observ-

ing fetal vascular hemodynamic changes 7,8.

Normally, with increasing gestational week,

the diastolic blood flow of the umbilical ar-

tery increases, and S/D, PI, and RI levels

decrease9,10. However, FGR may occur when

there is a decrease in villous vascular branch-

es, an increase in circulatory resistance, and

a decrease in the total cross-sectional area of

the vascularized lumen in the placenta, and

Table 4

Evaluation of pregnancy outcomes based on various parameters.

Indicator n Abnormal pregnancy outcome χ2 p

Mild hypoxia Severe hypoxia

RI of umbilical artery >0.66 60 23 (38.33) 37 (61.67) 1.114 0.291

RI of umbilical artery ≤0.66 15 8 (53.33) 7 (46.67)

RI of middle cerebral artery >0.69 55 15 (27.27) 40 (72.73) 16.816 <0.001

RI of middle cerebral artery ≤0.69 20 16 (80.00) 4 (20.00)

PSV/ESRV >3.36 53 17 (32.08) 36 (67.92) 6.386 0.012

PSV/ESRV ≤3.36 22 14 (63.64) 8 (36.36)

Count data were expressed by % and subjected to the χ2 test. ESRV: End systolic reflux velocity; PSV: peak systolic

velocity; RI: resistance index.

Table 5

Evaluation of fetal survival rate based on various parameters.

Indicator n Fetal outcome χ2 p

Survival Death

RI of umbilical artery >0.66 60 53 (88.33) 7 (11.67) 1.930 0.165

RI of umbilical artery ≤0.66 15 15 (100.00) 0 (0.00)

RI of middle cerebral artery >0.69 55 48 (87.27) 7 (12.73) 2.808 0.094

RI of middle cerebral artery ≤0.69 20 20 (100.00) 0 (0.00)

PSV/ESRV >3.36 53 46 (86.79) 7 (13.21) 3.205 0.073

PSV/ESRV ≤3.36 22 22 (100.00) 0 (0.00)

Count data were expressed by % and subjected to the χ2 test. ESRV: End systolic reflux velocity; PSV: peak systolic

velocity; RI: resistance index.

Evaluation of fetal growth restriction by color Doppler ultrasound 23

Vol. 66(1): 16 - 25, 2025

an elevation in S/D, PI, and RI levels of the

umbilical artery. In severe cases, the risk of

adverse events, such as intrauterine distress,

asphyxia, and even death of the fetus, may in-

crease 11,12. In this study, the RI, PI, and S/D

levels of umbilical artery in the FGR group

were significantly higher than those of the

healthy group (p<0.05), indicating that the

blood flow in the umbilical artery of fetuses

with FGR was in a high resistance state.

According to the hemodynamic princi-

ple of fetal placental circulation, villous vas-

cular bed increases in the second and third

trimesters of pregnancy, the resistance of

fetal placental circulation and the S/D de-

crease, and the placental blood flow increas-

es accordingly, which is conducive to the

growth and development of fetuses.13 The

results of this study revealed that the S/D

value of FGR fetuses significantly increased,

probably due to prolonged hypoxia and nu-

tritional deficiencies. Moreover, fetal devel-

opment is closely related to placental blood

flow. As a result, the S/D value indirectly

reflects the fetal-placental circulation state

and intrauterine conditions. Also, the ROC

curve analysis results showed that the AUCs

of RI, PI, and S/D of the umbilical artery in

the diagnosis of FGR were 0.893, 0.893 and

0.900 (p<0.05), respectively, indicating that

abnormal umbilical artery hemodynamics

can affect the supply of nutrients to fetuses.

Regular monitoring of umbilical artery he-

modynamic changes is favorable for the early

diagnosis and clinical management of FGR.

As an important branch of the inter-

nal carotid artery, the middle cerebral ar-

tery markedly affects the changes in fetal

cerebral circulation, and its hemodynamic

alterations are closely related to fetal cra-

nial blood circulation and hypoxia 14,15. In

the case of insufficient cerebral blood sup-

ply and oxygenation, the hypoxia and isch-

emia of the fetus are aggravated, causing

damage to other organs and affecting the

prognosis 16,17. In this study, the RI, PI, and

S/D levels of the middle cerebral artery in

the FGR group were significantly lower than

those in the healthy group (p<0.05), prob-

ably because FGR activated the cerebral pro-

tective effect to self-regulate and contract

peripheral vasculature to increase the blood

supply to the heart, brain, and other vital or-

gans. As a result, monitoring the changes in

the resistance parameters of the middle ce-

rebral artery can evaluate the effect of fetal

hypoxia on FGR. The results of ROC curve

analysis herein revealed that the AUCs of RI,

PI, and S/D of the middle cerebral artery in

the diagnosis of FGR were 0.812, 0.874, and

0.910 (p<0.05), with high specificity and

Youden index. Moreover, the analysis of preg-

nancy outcomes based on the cut-off value

of RI showed that a high proportion of fe-

tuses with severe hypoxia had an RI >0.69.

Therefore, the blood flow parameters of the

middle cerebral artery can be used as indica-

tors for the prenatal ultrasound diagnosis of

FGR.

PSV/ESRV can reflect the blood flow of

the aortic arch isthmus. When a fetus has

a reduced blood supply, the body activates

the compensatory mechanism to protect im-

portant organs such as the heart and brain

and increase the perfusion of such organs,

increasing ESRV level and decreasing PSV/

ESRV 18,19. In this study, the PSV/ESRV lev-

el of the aortic arch isthmus in the FGR

group was significantly lower than that in

the healthy group (p<0.05), suggesting that

FGR can also be evaluated based on hemo-

dynamic changes in the aortic arch isthmus.

Probably, the decreased blood oxygen level

during the increase in the resistance to fetal

peripheral blood flow cannot meet the needs

of fetal growth and development, so the body

initiates a compensatory mechanism to pro-

mote dilatation to increase the perfusion of

blood flow. Also, local anaerobic glycolysis

increases in a state of hypoxia, producing

metabolites such as lactate and adenosine,

which can dilate blood vessels and reduce

cardiac output 20. Additionally, the results of

ROC curve analysis revealed that the AUC of

PSV/ESRV of aortic arch isthmus in diagnos-

ing FGR was 0.857 (p<0.05), with the sensi-

24 Chen and Zhong

Investigación Clínica 66(1): 2025

tivity and specificity of 84.00% and 73.33%,

respectively. The infants with diagnostic val-

ue >3.36 accounted for a significantly high

proportion. This indicates that the blood

flow changes in the aortic arch isthmus

are valuable for diagnosing FGR. The early

monitoring of the PSV/ESRV level changes

is conducive to diagnosing FGR at an early

stage and can help guide the treatment.

In conclusion, fetal umbilical artery,

middle cerebral artery, and aortic arch isth-

mus parameters detected by CDUS are all

sensitive indicators for evaluating FGR, and

the determination of optimal diagnostic

value for each flow parameter is valuable for

the clinical determination of FGR and intra-

uterine hypoxia, and for improving the prog-

nosis. However, due to the short duration

of this study, the values of fetal parameters

detected by CDUS in evaluating the severity

and prognosis of FGR have not yet been ana-

lyzed. In the future, the research duration

will be increased, and the source of subjects

will be expanded for in-depth investigation.

Conflicts of interest

The authors declare they have no con-

flicts of interest.

Funding

This study was not financially supported

ORCID number of authors

• Yangyang Chen:

0009-0001-4366-6879

• Dongdong Zhong:

0009-0001-7291-0690

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