Comparison of Doppler findings and neonatal outcome in fetal growth restriction

Authors

  • Rekha B. R. Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India
  • Pavanaganga A. Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India
  • Sai Lakshmi M. P. A. Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India
  • Nagarathnamma R. Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170563

Keywords:

Abnormal Doppler indices, FGR, Neonatal morbidity

Abstract

Background: Fetal growth restriction (FGR) affects up to 5-10% of pregnancies. It is associated with increased perinatal mortality and morbidity. Doppler studies identify at risk fetuses and help in timing interventions and prognosticate outcomes. The ability of Doppler studies to predict neonatal outcome is studied here.

Methods: Prospective study of seventy-two women with singleton pregnancies with gestational age above 28 week and detected to have FGR was done. The patients were subjected to Doppler analysis. Abnormal Doppler indices were compared with neonatal outcomes such as NICU admission, ventilator or CPAP support, sepsis, phototherapy and perinatal mortality.

Results: Elevated umbilical artery PI, reduced middle cerebral artery PI and low CP ratio were found in 14, 18 and 36 fetuses. The sensitivity and specificity in predicting neonatal outcome was 25% & 75%, 58.1% and 62% and 17.9% and 75% for umbilical artery PI, MCA PI and CP ratio respectively. None of the Doppler indices showed significant p value. On testing, gestational age at delivery and length of NICU stay, gestational age was a significant determining factor with ‘p’ value of 0.003.

Conclusions: Antenatal Doppler analysis of UA and MCA can predict neonatal outcome in FGR fetuses. Though the ‘p’ value was not significant in this study, the sensitivity, specificity, positive predictive value and negative predictive value are comparable to other studies. Gestational age at delivery significantly influences neonatal outcome.

References

Filmar G, Panagopoulos G, Minior V, Barnhard Y, Divon MY. Elevated umbilical artery systolic/diastolic ratio in the absence of fetal growth restriction. Arch Gynecol Obstet. 2013;288(2):279-85.

Von Beckerath AK, Kollmann M, Rotky-Fast C, Karpf E, Lang U, Klaritsch P. Perinatal complications and long term neurodevelopmental outcome of infants with intrauterine growth restriction. Am J Obstet Gynecol. 2013;208(2):130.

Roy A, Mukherjee S, Bhattacharyya SK, Banerjee P, Das B, Patra KK. Perintal outcome in pregnancies with intra-uterine growth restriction by using umbilical and middle cerebral artery colour Doppler. Indian Med Assoc. 2012;110(3):154-7,163.

Unterscheider J, Daly S, Geary MP, Kennelly MM, Mc Auliffe FM, O'Donoghue K et al. Predictable progressive Doppler deterioration in IUGR: does it really exist? Am J Obstet Gynecol. 2013;209(6):539.

Bano S, Chaudhary V, Pande 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 Imag. 2010;20(1):20-5.

Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis and management. Review Article. Am J Obstet Gynecol. 2011;204(4):288-300.

Gupta BD, Sharma R, Shah K. Prediction of IUGR and adverse perinatal outcome by colour Doppler examination of UA PI and MCA:UA PI Ratio. Int J Contemp Med Res. 2016; 3(4):976-8.

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

Mishra D, Sakhi P, Saraf A, Gupta A, Soni K, Dhruw S. Role of obstetric Doppler in prediction of adverse perinatal outcome in intrauterine growth retardation and pregnancy induced hypertension. Sch J App Med Sci. 20131(6):1016-20.

Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol. 2000;16:407-13.

Downloads

Published

2017-02-19

Issue

Section

Original Research Articles