DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183794

Correlation of Doppler assessment of fetal aortic isthmus with perinatal outcome in intrauterine growth restriction

Bhoomika Tantuway, Y. M. Mala, Anju Garg, Reva Tripathi

Abstract


Background: The objective of the present study was to find out association between aortic isthmus Doppler changes and perinatal outcome in growth restricted fetuses with placental insufficiency.

Methods: It is a prospective case control study, cases were 43 pregnant women with fetal growth restriction (FGR) with abnormal umbilical artery (UA) Doppler while 43 pregnant women with FGR but normal UA doppler, matched with period of gestation were taken as control. The direction of blood flow in aortic isthmus studied which may be antegrade, absent or retrograde and correlation between qualitative parameters of umbilical artery, aortic isthmus and ductus venosus were studied. Quantitative parameters, PI and RI were also calculated. Patients were managed as per hospital protocols. Perinatal outcome and any adverse event e.g. stillbirth, neonatal death, respiratory distress syndrome, intensive care unit stay >14 days etc. was noted.

Results: The number of intrauterine death (IUD) and still birth was increased in women with absent and retrograde flow in aortic isthmus, 66.7% and 71.4% respectively (p value <0.001). Retrograde blood flow in the aortic isthmus is consistently associated with absent or reverse end diastolic velocity in umbilical artery and ductus venosus.

Conclusions: Doppler of aortic isthmus is an additional parameter to assess severity of FGR. It plays an important role in termination of preterm FGR fetuses.


Keywords


Aortic isthmus doppler, Doppler studies in fetal growth restriction, Ductus venosus, Intrauterine growth retardation, Still birth, Umbilical artery

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References


Adre J. Cerebral blood flow and metabolism in the developing fetus. Clinics Perinatol. 2009;36(3):513-30.

Gonzalez J, Stamilio D, Ural S, Macones G, Odibo A. Relationship between abnormal fetal testing and adverse perinatal outcomes in intrauterine growth restriction. Am J Obstet Gynecol. 2007;196(5):e48-51.

Padmagirison R, Rai L. Fetal Doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and fetal growth restriction. J Obstet Gynecol. 2006;56:134-8.

Fouron JC. The unrecognized physiological and clinical significance of the fetal aortic isthmus. Ultrasound Obstet Gynecol. 2003;22(5):441-7.

Fouron JC, Skoll A, Sonesson SE, Pfizenmaier M, Jaeggi E, Lessard M. Relationship between flow through the fetal aortic isthmus and cerebral oxygenation during acute placental circulatory insufficiency in ovine fetuses. Am J Obstet Gynecol. 1999;181(5):1102-7.

Makikallio K, Jouppila P, Rasanen J. Retrograde aortic isthmus net blood flow and human fetal cardiac function in placental insufficiency. Ultrasound Obstet Gynecol 2003;22(4):351-7.

Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Use of the 3‐vessel view to record Doppler velocity waveforms from the aortic isthmus in normally grown and growth‐restricted fetuses: comparison with the long aortic arch view. J Ultra Med. 2008;27(11):1617-22.

Acharya G. Technical aspects of aortic isthmus Doppler velocimetry in human fetuses. Ultrasound Obstet Gynecol. 2009;33(6):628-33.

M Rio M, Martinez JM, Figueras F, Bennasar M, Olivella A, Palacio M, et al. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;31(1):41-7.

Baschat AA. Ductus venosus Doppler for fetal surveillance in high-risk pregnancies. Clin Obstet Gynecol. 2010;53(4):858-68.

Hidar S, Zaafouri R, Bouquizane S, Chaieb A, Jerbi M, Bibi M, Khairi H. Prognostic value of fetal aortic isthmus Doppler waveform in intrauterine growth retardation: prospective longitudinal study. J Obstet Boil Reprod Paris. 2004;33(8):745-52.

Figuera F, Benavides A, Del Rio M, Crispi F, Eixarch E, Martinez J et al. Monitoring of fetuses with intrauterine growth restriction: Longitudinal changes in ductus venosus and aortic isthmus flow. Ultrasound Obstet Gynecol. 2009;33(1):39-43.