Role of doppler in fetal growth restriction
Keywords:Fetal growth restriction, Umbilical artery Doppler, Middle cerebral artery Doppler, Ductus venosus Doppler, Cerebro placental ratio
Background: Fetal growth restriction is an important and particularly challenging problem for modern obstetricians and paediatricians. The present study is to correlate the importance of Doppler velocimetry and perinatal outcome in cases of growth restricted foetuses by comparing perinatal outcome of control & study groups with normal and abnormal Doppler waveforms.
Methods: A study and a control group comprising of 50 pregnant women having growth restricted foetuses in each group was matched for all other confounding factors except for Doppler changes. These patients were followed up and the perinatal outcomes of FGR foetuses having Doppler changes was compared with those having normal Doppler studies.
Results: In our study, alteration in both MCA and UmbA Doppler was associated with perinatal morbidity and NICU admissions in 64% and mortality in 28%. Doppler changes showing altered CPR less than 1 had adverse outcome with NICU admission in 61% and mortality in 34%. Alteration in DV Doppler was associated with perinatal morbidity and NICU admissions in 17% cases and mortality in 83% cases, with no pregnancies having a healthy outcome. Among high-risk pregnancies with suspected IUGR, the use of Doppler assessment significantly decreases the likelihood of labor induction, caesarean delivery, and perinatal deaths.Conclusions: Abnormal Doppler waveform changes indicate adverse perinatal outcome of pregnancies with FGR. Doppler study helps to reduce perinatal mortality and morbidity by timely and appropriate interventions.
Middleton W, Kurtz AB, and Hertzberg BS in: Ultrasound: The Requisites, 2nd ed. Mosby. 2004:330–41.
Saraiya UB, Rao KA, Chatterejee A, Principles and Practice of Obstetrics and Gynecology for Postgraduates 2nd ed. Jaypee. 2003:112.
Baker PN, Kenny L. Obstetrics by ten teachers, 18th ed. London: Hodder Arnold. 2006:156–70.
Sheppard BL, Bonnar J. An ultrastructural study of utero-placental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation. Br J Obstet Gynaecol. 1981;88:695–705.
Reuwer PJ, Sijmons EA, Rietman GW, van Tiel MW, Bruinse HW. Intrauterine growth retardation: prediction of perinatal distress by Doppler ultrasound. Lancet. 1987;22:415–18.
Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of a loss of end-diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound. Gynecol Obstet Invest. 1988;25:173–80.
Karowicz-Bilińska A, Sieroszewski P, Kowalska-Koprek U. The value of Doppler velocimetry in umbilical and cerebral artery in pregnancy complicated by IUGR and its influence on mode of delivery and neonatal Apgar score. Ginekol Pol. 2006;77(12):945-51.
Hecher K, Hackeloer BJ. Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: longitudinal observations. Ultrasound Obstet Gynecol. 1997;9:152–61
B.M. Lakhakar, H.V. Rajgopal P.T. Gourishankar. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian Jn of Radiology. 2006;16:2006,109-16.
Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral - Umbilical Doppler Ratio As a Predictor of Adverse Perinatal Outcome. Obstetrics and Gynaecology. 1992;79:416-20.
Gudmundsson S, Tulzer G, Huhta JC. Venous Doppler in the foetus with absent end diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol. 1996;7:262-7.
Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. AJOG. 2012;206:4:300-308.
Rizzo G, Capponi A, Arduini D, Romanini C. the value of fetal arterial, cardiac and venous flows in predicting pH and blood gases measured in umbilical blood at cordocentesis in growth retarded foetuses. BJOG. 1995;102: 963–9.
Fong KW, Ohlsson A, Hanah Me, Kingdom J, et al. Prediction of Perinatal Outcome in Foetuses Suspected to Have Intrauterine Growth Restriction. Radiology. 1999;213:681-9.