DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200886

The predictive role of color doppler sonography in evaluating hypoxia and acidosis in intrauterine growth restriction fetuses: correlation with arterial blood gas analysis

Triptpal Kaur, Reema Kumar Bhatt

Abstract


Background: Doppler is an ultrasound technique allowing non-invasive measurement of artery blood flow velocities. Objective of this study was to evaluate the role of umbilical artery (UA) and middle cerebral artery (MCA) Doppler study in predicting fetal hypoxia and acidosis in IUGR fetus and a population subjected to hematologic fluctuations.

Methods: In this study 100 subjects with IUGR fetuses was evaluated for comparison of Doppler sonography analysis of fetal middle cerebral arteries and umbilical arteries and cord blood samples (pCO2, pO2) that was collected at the time of delivery.

Results: Among the 100 subjects (between 28-32 gestational week) of IUGR showed a high risk of hypoxia and acidosis type condition. The observations were recorded in terms of MCA/UA ratio, the abnormal MCA/UA ratio was observed in significant (p<0.05) number of patients growth restricted fetuses (n=96), as compared to normal. There is a direct correlation found in the pH and pCO2 values. The results of arterial blood gases with respect to pH were found to be less than 7.3±1.6 in 96 subjects with abnormal MCA/UA ratio as compared to normal, that relates to the increase in the relative pCO2 (61.66%) [Acid increase] and decrease in pO2 arterial gases (Hpoxia increase).

Conclusions: The study provides an insight that shows IUGR fetuses have a relatively higher risk of hypoxia (less oxygen) and acidosis (low pH and high pCO2), showed the most important determinants variations.


Keywords


Acidosis, Doppler sonography, Fetus, Hypoxia, Intrauterine growth reduction

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References


ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019;133(2):e97-e109.

Battaglia FC, Lubchenko LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71:159-63.

Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333-9.

Anderson NH. Maternal and pathological pregnancy characteristics in customized birth weight centiles and identification of at-risk small-for-gestational-age infants: a retrospective cohort study. BJOG. 2012;119:848-56.

Gardosi J. Maternal and fetal risk factors for stillbirth: population-based study. BMJ. 2013;24.

Albu AR, Anca AF, Horhoianu VV, Horhoianu IA. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7(2):165-71.

Ott WJ. The diagnosis of altered foetal growth. Obstet Gynecol Clin North Am. 1988;15:237-63.

Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformations or developing circulatory compromise. Ultrasound Obstet Gynecol. 2010;36(1):93-111.

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

Simanaviciute D, Gudmundsson S. Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies. Ultrasound Obstet Gynecol. 2006;28:794-801.

Shahinaj R, Manoku N, Kroi E, Tasha I. The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prenat Med. 2010;4(2):17-21.

Manning FA, Hill CM, Platt LD. Qualitative amniotic fluid volume determination by ultrasound: antepartum detection of intrauterine growth retardation. Am J Obstet Gynecol. 1981;139(3):254-8.

Sankaran S, Kyle PM. Aetiology and pathogenesis of IUGR. Best Pract Res Clin Obstet Gynaecol. 2009;23(6):765-77.

Fardiazar Z, Atashkhouei S, Yosefzad Y, Goldust M, Torab R. Comparison of fetal middle cerebral arteries, umbilical and uterin artery color Doppler ultrasound with blood gas analysis in pregnancy complicated by IUGR. Iranian J Reprod Med. 2013;11(1):47.

Rhee E, Detti L, Mari G. Superior mesenteric artery flow velocity waveforms in small for gestational age fetuses. J Matern Fetal Med. 1998;7:120-3.

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.

Mari G, Abuhamad AZ, Uerpairojkit B, Martinez E, Copel JA. Blood flow velocity waveforms of the abdominal arteries in appropriate- and small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 1995;6:15-8.

Sohn C, Meyberg G. Initial experiences with a new color technique: ultrasound angiography. Zentralbl Gynakol. 1995;117:90-6.

Salihagić-Kadić A, Medić M, Jugović D, Kos M, Latin V, Kušan Jukić M, et al. Fetal cerebrovascular response to chronic hypoxia-implications for the prevention of brain damage. J Maternal-Fetal Neonat Med. 2006;19(7):387-96.

King T, Parer J. The physiology of fetal heart rate patterns and perinatal asphyxia. J Perinat Neonat Nurs. 2000;14(3):19-39.

Yalti S, Oral Ö, Gürbüz B, Özden S, Atar F. Ratio of middle cerebral to umbilical artery blood velocity in preeclamptic and hypertensive women in the prediction of poor perinatal outcome. Ind J Med Res. 2004;120(1):44.

Banu AA. Doppler velocimetry in the umbilical and middle cerebral arteries in fetuses with intrauterine growth retardation or fetal distress. Fukuoka Igaku Zasshi. 1998;89(5):133-44.

Xu W, Yang Q, Zhu T. Colour Doppler ultrasonographic indices in predicting fetal hypoxia and acidosis Zhonghua Fu Chan KeZa Zhi. 1997;32(6):341-4.