Doppler prediction of adverse perinatal outcome in intrauterine growth restriction

Nina Mahale, Bandana Khanal, Ajit Mahale, Merwyn Fernandes, Pallavi Rao, Chanabasappa Chavadi

Abstract


Background: Objective of current study was to determine and compare the diagnostic performance of Doppler ultrasonography of the fetal Middle Cerebral Artery (MCA) and Umbilical Artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth restriction (IUGR).

Methods: Fifty singleton pregnancies in third trimester of pregnancy with suspected intrauterine growth restriction were examined with Doppler ultrasonography of fetal MCA and UA.

Results: Twenty patients of the fifty included patients had at least one major or minor adverse outcome. Major adverse outcome included perinatal deaths which included both intrauterine deaths and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, necrotizing enterocolitis and septicemia. Minor outcomes included cesarean section for fetal distress, Apgar score below 7 at 5 minutes and admission to Neonatal Intensive Care Unit (NICU) for treatment. MCA PI is the most sensitive(90%) index in predicting any adverse perinatal outcome i.e. including both major and minor outcomes, Positive Predictive Value (PPV) and specificity being greatest for MCA/UA PI (96.6%, 93.7%). For the major adverse outcome most sensitive (86.6%) most specific (91.4%) and with highest PPV (81.2%) and NPV (94.1%), is MCA/UA PI. Ratio of MCA/UAPI is more sensitive (90%) than PI of both the arteries alone for overall prediction of adverse perinatal outcome.

Conclusions: Thus we conclude that the Doppler studies of the multiple vessels in the fetoplacental unit can help in the monitoring of the compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of deliveries in pregnancies complicated by IUGR.


Keywords


Adverse outcome, Doppler, Pregnancy IUGR

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References


Giampaolo Mandruzzato, Aris Antsaklis, Francesc Botet, Frank A. Chervenak, Francisc Figueras, Amos Grunebaum, et al. Intrauterine restriction (IUGR). J Perinat Med. 2008;36(4):277-81.

Adre J. du Plessis. Cerebral blood flow and metabolism in the developing fetus. Clin Perinatol. 2009:36(3):531-48.

Scifres CM, Stamilio D, Macones GA, Odibo AO. Predicting perinatal mortality in preterm intrauterine growth restriction. Am J Perinatal. 2009;26(10):723-8.

Kingdom JC, Burrell SJ, Kaufmann P. Pathology and clinical implications of abnormal umbilical artery Doppler waveforms. Ultrasound Obstet Gynecol. 1997;9(4):271-86.

Wolfe HM, Gross TL, Sokol RJ. Recurrent small for gestational age birth: perinatal risks and outcomes. Am J Obstet Gynecol. 1987;157(2):288-93.

Gardosi J, Mul T, Mongelli M, Fagan D. Analysis of birth weight and gestational age in antepartum stillbirths. Br J Obstet Gynecol. 1998;105(5):524-30.

Seeds JW. Impaired fetal growth: ultrasonic evaluation and clinical management. Obstet Gynecol. 1984;64(4):577-84.

Trudinger BJ, Giles WB, Cook CM. Flow velocity waveforms in the maternal uteroplacental and fetal umbilical circulations. Am J Obstet Gynecol. 1985;152(2):155-63.

9.Fleischer A, Schulman H, Farmakides G, Bracero L, Blattner P, Randolph G. Umbilical artery velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151(4):502-5.

Campbello S, Diaz-Recasens J, Griffin DR, Cohen-Overbeek TE, Pearce JN, Willson K, et al. New Doppler technique for assessing utero placental blood flow. Lancet. 1983;321(8326):675-7.

Kurmanavicius J, Florio I, Wisser J, Hebisch G, Zimmermann R, Müller R, et al. Reference resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24-42 weeks of gestation. Ultrasound Obstet Gynecol. 1997;10(2):112-20.

.Gramellini D, Folli MC. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol. 1992;79:416-20.

Mari G, Deter RL. Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses. Am J Obstet Gynecol. 1992;166:1262-70.

Madazli R. Prognostic factors for survival of growth-restricted fetuses with absent end-diastolic velocity in the umbilical artery. J Perinatol. 2002 Jun;22(4):286-90.

Yoon BH, Lee CM, Kim SW. An abnormal umbilical artery waveform; a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obstet Gynecol. 1994;171:713-21.

Giles WB. Vascular Doppler techniques. Obstet Gynecol Clin North Am. 1999 Dec;26(4):595-606, vi.

Meyberg GC, Solomayer EF, Grishke EM, Bastert G. Does the measurement of four fetal arteries provide more information than the measurement of just two arteries in perinatal Doppler sonography? Ultrasound Obstet Gynecol. 1999;13:407-14.

Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging. 2006;16:109-16.