DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20185062

Maternal risk factors and perinatal outcomes in fetal growth restriction using obstetric Doppler in South Kerala, India

Heera Shenoy T., Sonia X. James, Sheela Shenoy T.

Abstract


Background: Fetal Growth Restriction (FGR) is the single largest contributing factor to perinatal morbidity in non-anomalous foetuses. Synonymous with Intrauterine Growth Restriction (IUGR), it is defined as an estimated fetal weight less than the10th percentile. Obstetric Doppler has helped in early detection and timely intervention in babies with FGR with significant improvements in perinatal outcomes.  Hence, authors evaluated the maternal risk factors and diagnosis-delivery intervals and perinatal outcomes in FGR using Doppler.

Methods: This research conducted in a tertiary care hospital in South Kerala included 82 pregnant women who gave birth to neonates with birth weight less than the 10th percentile over a period of1 year (Jan 1, 2017-Dec 31, 2017). Socio-demographic, maternal risk, Diagnosis- delivery interval in FGR and neonatal morbidities were studied.

Results: Mean GA at diagnosis in weeks was 34.29 and 35.19 respectively for abnormal and normal Doppler respectively (p value-0.032). The mean birthweight in Doppler abnormal FGR was 272.34 g lesser than in Doppler normal group (p value-0.001). Growth restricted low birth weight neonates had Doppler   pattern abnormalities (p value-0.0009). FGR <3rd percentile and AFI <5 had abnormal Doppler (OR:6.7). Abnormal biophysical profile (OR:14) and Non-Reactive NST (OR:3.5) correlated with abnormal Doppler. Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).

Conclusions: Abnormal Doppler velocimetry is significantly associated with earlier FGR detection, shorter decision- delivery interval, reduction in the mean birthweight and longer NICU stay. Hence, Umbilical artery Doppler and Cerebroplacental index is an integral part of in-utero fetal surveillance to identify impending fetal hypoxia, appropriate management, optimising the timing of delivery and improve perinatal health in FGR.


Keywords


Abnormal, Birthweight, Centile, Doppler, Fetal, Growth, Intrauterine, Neonatal, Normal, Restriction

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References


Cochran WD, Lee KG. Assessment of the new-born. Manual of Neonatal Care. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2004.

Unterscheider J, O’Donoghue K, Daly S, Geary MP, Kennelly MM, McAuliffe FM, et al. Fetal growth restriction and the risk of perinatal mortality–case studies from the multicentre PORTO study. BMC Preg Childbirth. 2014;14(1):63.

Fetal growth disorders. In Williams Obstetrics. 24th ed. New York, NY: Mc Graw Hill; 2013:872-890.

Fitzhardinge PM, Steven EM. The small-for-date infant. II. Neurological and intellectual sequelae. Pediatrics. 1972;50(1):50-7.

Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98.

Bilardo CM, Wolf H, Stigter RH, Ville Y, Baez E, Visser GH, Hecher K. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet Gynecol. 2004;23:119-25.

Gagnon R, Van Den HM. The use of foetal Doppler in obstetrics. J Obstet Gynaecol Can. 2003;25(7):601-14.

Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian Radiol Imag. 2006;16(1):109.

Bano S, Chaudhary V, Pandey S, Mehta VL, Sharma AK. 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;20:20-5.

Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch U, et al. Progression of Doppler abnormalities in intrauterine growth restriction: Ultrasound Obstet Gynecol. 2008;32:160-7.

Savchev S, Figueras F, Cruz Martinez R. Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age fetuses with normal umbilical, brain and uterine Doppler. Ultrasound Obstet Gynecol. 2012;39:299-303.

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.

de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr 1998;52(suppl 1):S5-S15.

Chandra S, Mathews SC. Perinatal morbidity and mortality in low birthweight babies. J Obstet Gynaecol India. 2003:53(3):237.

Singh A, Ambujam K. Maternal socio-demographic determinants and fetal outcome of intrauterine growth restriction. Int J Reprod Contracept Obstet Gynecol. 2018;7:3843-7.

Satyavrathan V, Ahmed N, Sundrappa S. Study of perinatal outcomes of pregnancies with intrauterine growth restriction in a tertiary care centre in North Kerala. J Evid Based Med Healthc. 2017;4(37):2203-8.

Seal A, Dasgupta A, Sengupta M, Dastider R, Sen S. Analysis of fetal growth restriction in pregnancy in subjects attending in an obstetric clinic of a tertiary care teaching hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7:973-80.

Ghazi HA, Spielberger C, Kallen B. Delivery outcome after infertility: a registry study. Fertil Steril. 1991;55:726-32.

Motghare DD, Frederick SV, Pawaskar M, Kulkarni MS. Maternal determinants of intrauterine growth restriction in Goa, India: a case-control study. Global J Medic Public Health. 2014;3(1):O8.

Bassetty KC, Phukan P, Ahmed RD, Borah R. Outcomes of Neonates in Pregnancies with Intrauterine Growth Restriction in Developing Countries: A Cross-sectional Study Over a Period of 6 Months. Gynecol Obstet (Sunnyvale). 2017;7:434.

Sharma DD, Chandnani KC. Clinical study of IUGR cases and correlation of Doppler parameters with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2016;5:4290-6.

Jamal M, Khan N. Maternal factors associated with low birth weight. J Coll Physicians Surge Pak. 2003;13:25-8.

Sinha S, Kurude VN. Study of obstetric outcome in pregnancies with intrauterine growth retardation. Int J Reprod Contracept Obstet Gynecol. 2018;7:1858-63.

Rajarajeswari R, Thendral V. Prediction of perinatal outcome with umbilical artery Doppler in IUGR fetuses- a prospective analytical study in a tertiary medical college in Tamilnadu, India. Int J Reprod Contracept Obstet Gynecol. 2017;6:1097-104.

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

Malhotra N, Chanana C, Kumar S, Roy K, Sharma JB. Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006;60(8):311-7.

Rekha BR, Pavanaganga A, Lakshmi SMPA, Nagarathnamma R. Comparison of Doppler findings and neonatal outcome in fetal growth restriction. Int J Reprod Contracept Obstet Gynecol. 2017:6:955-8.

Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 2007;109:253-61.

Ebrashy A, Azmy O, Ibrahim M, Waly M, Edris A. Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: case-control study. Croatian Med J. 2005;46(5).

Thomas JS, Malliga A, Sethurajan S. Significance of umbilical artery Doppler velocimetry in the perinatal outcome of growth restricted fetuses. Int J Reprod Contracept Obstet Gynecol. 2018;7:1074-8.

Pallotto EK, Kilbride HW. Perinatal outcome and later implications of intrauterine growth restriction. Clinical Obstet Gynecol. 2006;49(2):257-69.

Rutherford SE, Phelan JP, Smith CV, Jacobs N. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol. 1987;70(3 Pt 1):353-6.

Manning FA, Harman CR, Morrison I, Menticoglou SM, Lange IR, Johnson JM. Fetal assessment based on fetal biophysical profile scoring. IV.An analysis of perinatal morbidity and mortality. Am J Obstet Gynecol. 1990;162(3):703-9.

Cosmi E, Ambrosini G, D'antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth restricted fetuses. Obstet Gynecol. 2005;106:1240-5.

Grivell RM, Alfirevic Z, Gyte GM, Devane D. Antenatal cardiotocography for fetal assessment. Cochrane Database Syst Rev. 2010;1.