Prediction of perinatal outcome with umbilical artery Doppler in IUGR fetuses- a prospective analytical study in a tertiary medical college in Tamilnadu, India

Rajarajeswari R., V. Thendral


Background: Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight alone in intrauterine growth restricted (IUGR) fetuses. Perinatal mortality and morbidity are increased if the umbilical artery Doppler abnormality worsens.

Methods: This study was conducted in Department of Obstetrics and Gynaecology, Thanjavur medical college from August 2015 to August 2016. One hundred singleton pregnancies complicated by IUGR beyond 32 weeks were subjected for Doppler study of umbilical artery. Perinatal outcome in terms of baby outcome, birth weight, early neonatal death, admission in NICU and duration of admission in NICU were analysed.

Results: The main indication of termination of pregnancy was oligohydramnios (70%). The other causes of termination were 8% for uncontrolled hypertension and 4 % for post term. 60 % were delivered vaginally and 40% by lower segment cesarean section. Various indication for LSCS were Non-reactive CTG, fetal distress, severe oligohydramnios and failed induction. 92% were delivered alive babies and 8% still born babies. Birth weight of the babies varied from 900gm to 2.5Kg. But patients with absent or reversed end diastolic flow in umbilical artery Doppler, 80% of the babies weighed less than 1.5Kg. Perinatal mortality in our study is 19% which includes 8% of intrapartum mortality and 11% of neonatal mortality and perinatal morbidity is 24%. When the diastolic flow in the umbilical artery is, absent or reversed, it is associated with increased perinatal mortality of 80%.

Conclusions: The results of present study clearly demonstrated the efficacy of umbilical artery Doppler in predicting the fetal outcome. To improve the predictive value of this tool, a better method is needed to assess the wellbeing of the IUGR fetuses such as integrated antenatal test which combines BPP and Doppler study employing other vessels.



IUGR, Perinatal mortality and morbidity, Umbilical artery Doppler study

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Seeds JW. Impaired fetal growth: definition and clinical diagnosis. Obstet Gynecol. 1984;64(3):303-10.

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

Bhide, Arulkumaran, Damania, Daftary. Arias’ Practical guide to high-risk pregnancy and delivery: A South Asian perspective, 4th ed. 2015:88-103.

McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. New England J Med. 1999;340(16):1234-8.

Cemace Perinatal Mortality 2008. London, UK: Centre for Maternal and Child Enquiries; 2010.

Briana DD, Malamitsi-Puchner A. Intrauterine growth restriction and adult disease: the role of adipocytokines. Eur J Endocrinol. 2009;160(3):337-47.

Ott WJ. Intrauterine growth restriction and Doppler ultrasonography. J Ultrasound Med. 2000;19(10):661-5.

Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound in obstetrics and gynecology: In Soc Ultrasound Obstet Gynecol. 2013;41(2):233.

Morris RK, Malin G, Robson SC, Kleijnen J, Zamora J, Khan KS. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high‐risk population: systematic review and bivariate meta‐analysis. Ultrasound Obste Gynecol. 2011;37(2):135-42.

Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high‐risk pregnancies. cochrane Database Syst Rev. 2010;(1):CD007529.

Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of blood velocity and pulsatility index at the intra‐abdominal portion, and fetal and placental ends of the umbilical artery. Ultrasound Obstet Gynecol. 2005;26(2):162-9.

Dicke JM, Huettner P, Yan S, Odibo A, Kraus FT. Umbilical artery doppler indices in small for gestational age fetuses’ correlation with adverse outcomes and placental abnormalities. J Ultrasound Med. 2009;28(12):1603-10.

Berkowitz Gs, Mehalek Ke, Chitkara U, Rosenberg J, Cogswell C, Berkowitz Rl. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynecol. 1988;71(5):742-6.

Divon MY, Guidetti DA, Braverman JJ, Oberlander E, Langer O, Merkatz IR. Intrauterine Growth retardation-a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry. Obstet Gynecol. 1988;72(4):611-4.

Dhand H, Kansal HK, Dave A. Middle cerebral artery Doppler indices better predictor for fetal outcome in IUGR. J Obstet Gynecol India. 2011;61(2):166-71.

Byun YJ, Kim HS, Yang JI, Kim JH, Kim HY, Chang SJ. Umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age infants. Yonsei Med J. 2009;50(1):39-44.

Urmila S, Beena B. Triple vessel wave pattern by Doppler studies in normal and high risk pregnancies and perinatal outcome. J Obstet Gynecol India. 2010;60(4):312-6.

Deshmukh A, Neelu S, Suneeta G. Significance of umbilical artery Doppler velocimetry in the perinatal outcome of the growth restricted fetuses. J Obstet Gynecol. 2010;60(1):38-43.

Narulla H, Kapila AK, Kaur MM. Cerebral and umbilical arterial blood flow velocity in normal and growth retarded pregnancy. J Obstet Gynecol India. 2009;59(1):47-52.

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

Khalid M, Wahab S, Khalid VK, Haroon S, Sabzposh NA. Doppler indices in prediction of fetal outcome in hypertensive pregnant women. Nepal J Obstet Gynaecol. 2015;6(1):28-34.

Bhatt CJ, Arora J, Shah MS. Role of color Doppler in pregnancy induced hypertension (a study of 100 cases). Indian J Radiol Imag. 2003;13(4):417.

Figueras F, Eixarch E, Gratacos E, Gardosi J. Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small‐for‐gestational‐age babies according to customised birthweight centiles: population‐based study. BJOG: Int J Obstet Gynaecol. 2008;115(5):590-4.

Neilson JP, Alfirevic Z. Doppler ultrasound for fetal-assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;(2):CD 000073.