A prospective study to evaluate the role of routine early third trimester ultrasound in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome using color Doppler


  • Shabd Singh Yadav Department of Paediatrics, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
  • Aditi Singh Department of Obstetrics and Gynecology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India http://orcid.org/0000-0003-0565-601X
  • Kalpana Yadav Department of Obstetrics and Gynecology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India




IUGR, Colour Doppler, Cerebroplacental ratio, Perinatal morbidity


Background: Intrauterine growth restriction (IUGR) is a major and silent cause of perinatal morbidity and mortality. Rate of IUGR in developing countries is 6 times higher than that of developed countries. 14 to 20 million infants are affected with IUGR in developing countries annually. The highest incidence is found in south central Asia (33%) and India (21%). Aim of study was to evaluate the role of early 3rd trimester ultrasound in diagnosis and role of color Doppler in prediction of adverse perinatal outcome in IUGR.

Methods: A prospective case-control study was conducted on 720 women admitted in GMH Rewa for one year. 360 antenatal cases diagnosed as IUGR on ultrasound were taken as study group, same number of non IUGR cases were taken as control. Study cases were followed with Doppler. The umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebro-placental ratio were calculated and the results were analysed.

Results: Inferences drawn from the study were: rate of caesarean section was significantly higher (31%) in study group, perinatal outcome was poor in more number of cases (10.8%) in study group than the control group (3.4%), and the sensitivity and specificity of cerebroplacental ratio was more reliable indicator in comparison to that of UA PI and MCA PI in prediction of adverse perinatal outcome.

Conclusions: Looking at the high burden of IUGR cases in our country and its adverse effects on perinatal outcome, if early third trimester ultrasound is made mandatory for all pregnant women, most of the IUGR cases can be detected and managed timely and perinatal outcome can be significantly improved.


Battalglia FC, Lubchenco LO. A practical classification of new born infants by weight and gestational age. J Paediatr.1967;71(2):159-63.

World Health Organization. Expert Committee Report: Physical status: the use and interpretation of anthropometry. Technical Report Series 854. Geneva: World Health Organization. 1995.

De Onis M, Blössner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clini Nutr.1998;52(1):5-15.

Director General World Health Organization. Bridging the gaps. The World Health Report. 1995.

Barker DJ, Osmond C, Golding J, Kuh D, Wadsworth ME. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ. 1989;298(6673):564-7.

Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005;331:1113.

Lean SC, Heazell AEP, Dilworth MR, Mills TA, Jones RL. Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women. Sci Rep. 2017;7(1):9677.

Ravikumar K, Rajeshkannan B. A Descriptive Study of Maternal Risk Factors in Term Babies with IUGR. J Dent Med Sci. 2016;15(12):48-51.

Odibo AO, Nelson D, Stamilio DM, Sehdev HM, Macones GA. Advanced maternal age (AMA) is an independent risk factor for intrauterine growth restriction (IUGR). Am J Perinatol. 2006;23(5):325-8.

Kramer MS. Determinants of low birth weight: Methodological assessment and meta-analysis. Bull World Health Organiz.1987;65:663-737.

Acharya D, Nagraj K, Nair NS, Bhat HV. Maternal determinants of intrauterine growth retardation: a case control study in Udupi district, Karnataka. Ind J Comm Med. 2004;29(4):10-2.

Bassetty KC, Phukan P, Ahmed RD, Borah R. Outcomes of Neonates in Pregnancies with Intrauterine Growth Restriction in Developing Countries: A Cross-sectional Study Over a Period of 6 Months. Gynecol Obstet 2017;7:434.

Morris RK, Meller CH, Tamblyn J, Malin GM, Riley RD, Kilby MD, et al. Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: Systematic review and meta-analysis. BJOG. 2014;121(6):686-99.

Ryan D, Black MJ. Preterm Birth and or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney. J Neonatal Biol. 2015;4:168.

Unterscheider J, Daly S, Geary MP. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208(4):2901-6.

Sharma D, Shastri S, Farahbakhsh N, Sharma P. J Matern Fetal Neonatal Med. 2016; 29(24):3977-87.

Larciprete G, Valensise H, Di Pierro G, Vasapollo B, Casalino B, Arduini D, Jarvis S, Cirese E. Intrauterine growth restriction and fetal body composition. Ultrasound Obstet Gynecol. 2005;26:258-62.

Baschat AA, Weiner CP. Umbilical artery Doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol. 2000;182:154-8.

Vandenbosche RC, Kirchner JT. Intrauterine growth retardation. Am Fam Physician. 1998;58(6):1384-90.

Khanduri S, Parashari UC, Bashir S, Bhadury S, Bansal A. Comparison of Diagnostic Efficacy of Umbilical Artery and Middle Cerebral Artery Waveform with Color Doppler Study for Detection of Intrauterine Growth Restriction. J Obstet Gynaecol India. 2013;63(4):249-55.

Malik R, Saxena A. Role of Colour Doppler Indices in the Diagnosis of Intrauterine Growth Retardation in High-Risk Pregnancies. J Obstet Gynaecol India. 2013;63(1):37-44.

Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, Mari G. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol. 1999;180(3 Pt 1):750-6.

Gandhi K, Mehta AV. Role of Doppler Velocimetry in growth restricted foetuses. NHL J Med Sci. 2015;4(1):27-30.

De Vore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA foetuses. Am J Obstet Gynecol. 2015;213(1):5-15.






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