Obstetric Doppler studies in prediction of perinatal outcome in intrauterine growth restriction

Authors

  • Pradip R. Gaikwad Department of Obstetrics and Gynecology, ESI-Postgraduate Institute of Medical Science and Research, Andheri, Mumbai, Maharashtra, India
  • Sarah Zaidi Department of Obstetrics and Gynecology, ESI-Postgraduate Institute of Medical Science and Research, Andheri, Mumbai, Maharashtra, India
  • Meenakshi Rana Department of Obstetrics and Gynecology, ESI-Postgraduate Institute of Medical Science and Research, Andheri, Mumbai, Maharashtra, India
  • Vidyadhar Suryakar Department of Radiodiagnosis, ESI-Postgraduate Institute of Medical Science and Research, Andheri, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184148

Keywords:

Cerebroplacental ratio, Color Doppler, Intrauterine growth restriction, Perinatal outcome

Abstract

Background: Fetal surveillance of the pregnancies that are complicated by IUGR is essential to improve fetal outcome. Colour Doppler studies of uteroplacental and fetoplacental circulation are useful in identification of hypoxemic status of the fetus and allows timely intervention in at risk fetuses. The present study was aimed to know the significance of colour Doppler studies in intrauterine growth restriction cases and to correlate with the perinatal outcome thus to offer better strategies for early diagnosis of compromised fetus and timely intervention.

Methods: This was a prospective study of 125 singleton pregnancies in the third trimester with IUGR. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.

Results: In the present study 63 patients had one or more adverse perinatal outcome parameter. The diagnostic accuracy of umbilical artery was more (71.20%) than other parameters in predicting adverse perinatal outcome. Middle cerebral artery RI was having highest specificity and positive predictive value of 100% than any other parameter in predicting adverse perinatal outcome. Patients with AEDF and REDF had 33.3% and 50% perinatal deaths respectively.

Conclusions: Middle cerebral artery Doppler studies shown more specificity and positive predictive value than umbilical artery Doppler in prediction of adverse perinatal outcome.

References

F. Gary Cunningham, Kenneth JL, Steven LB, John CH, Larry CG III, Katherine DW. Williams Obstetrics 24th edition, New York: Mc Graw Hill Education, 2014.

American College of Obstetricians and Gynaecologists. Intrauterine growth restriction; ACOG practice bulletin no. 12. Washington, DC: ACOG; 2000. Level III.

de Onis M, Blossner M, Villar J: Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998; 52(l):S5-15.

Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol. 2003;27(4):281-7.

Mari G, Piconi J. Doppler vascular changes in IUGR. Perinatol. 2008;32(3):182-9.

Jardosh Y, Mahesh K, Purvi Desai. Color Doppler study in the evaluation of Intrauterine Growth Restriction. Int J Sci Res 2016;5(8):932-5.

Lakshmi V, Indira K, Neeraja M, P Chandrashekhar Rao. Role of Doppler in pregnancy induced hypertension and IUGR. Int J Res Health Sci. 2015;3(1):191-8.

Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging. 2006; 16(1):10-16.

Odibo AO, Riddick C, Pare E, Stamilio DM, Macones GA. Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: evaluating the impact of using gestational age-specific reference values. J Ultrasound Med. 2005;24(9):1223-8.

Ulkumen B, Pala H, Baytur Y, Koyuncu FM. The analysis of Doppler flow alterations in intrauterine growth restricted pregnancy. Med Sci Discover 2014,1(3):80-4.

Kumbar VG, Vijayalakshmi N, Joseph VX, Thomas R, Kaneria TN, Sandeep MB, ET AL. Role of color Doppler evaluation of middle cerebral and umbilical artery in intrauterine growth restriction and prediction of adverse perinatal outcome. Int J Rec Trends Sci Technol. 2014;12(3):449-53.

Netam SBS, Abha S, Dutt V, Singh R, Mandle H. Best color Doppler indices in prediction of fetal hypoxia in IUGR fetuses. Int J Med Res Rev. 2015;3(9): 1012-1019.

Purushotham V, Laxmi G, Swati K. Comparison of Biophysical Profile and Doppler ultrasound in predicting perinatal outcome in high risk pregnancies at or over 34 weeks gestation. Int J Innovat Res Develop.2015;4 (103):360-5.

Gramellini D, Folli MC, Raboni S. Cerebral-umblical Doppler ratio as a predictor of adverse perinatal outcome. Obstet and Gynecol 1992,79(3); 416.

Yoon BH, Lee PR, Oh IH, Kim WJ, Syn HC, Kim SW. Is an abnormal Doppler umbilical artery waveform ratio a risk for poor perinatal outcome in the non-small for gestational age fetus, Am J Perinatol. 1993;10(3):245-9.

Bano S, Chaudhary V, Pande S, Vl Mehta, AK Sharma. Color Doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. Indian J Radiol Imaging. 2010;20(1):20-5

S Khanduri, Singh S, Kumkum S, Urvashi V. Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery with color Doppler study for detection of intrauterine growth retardation. J Obstet Gynecol India 2013;63(4):249-55.

Arduini DO, Rizzo GI, Romanini CA. Changes of pulsatility media from fetal vessels preceeding the onset of later decelerations in growth retarded fetuses. Obstetrics and Gynaecology 1992;79(4):605-10.

Fong KW, Ohlsson A, Hannah ME, Grisaru S, Kingdom J, Cohen H, et al. Prediction of perinatal outcome in fetuses suspected to have intrauterine restriction; Doppler study of fetal cerebral, renal and umbilical arteries. Obstetric Imag Radiol, 1999;213(3):681-9.

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Published

2018-09-26

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Original Research Articles