Abstract
Introduction: Intra uterine growth restriction (IUGR) is associated with increased perinatal mortality, morbidity and impaired neurodevelopment. Doppler velocimetry can assess the fetal hypoxia thereby deciding the timing of delivery and avoiding prematurity.
Objective: To predict the perinatal outcome in IUGR fetuses by Doppler velocimetry of umbilical artery, middle cerebral artery and descending thoracic aorta and deciding the management accordingly.
Material and methods: Twenty five IUGR fetuses were subjected for Doppler velocimetry of umbilical artery (UA), middle cerebral artery (MCA) and descending thoracic aorta (DTA). S/D ratio, PI and RI were calculated to predict he fetal hypoxia.
Observations: Umbilical artery S/D ratio was increased in 52% cases, whereas PI and RI were increased in 48% and 40% cases respectively. AEDV was found in 12% and REDV in 4% cases and were associated with 75% mortality. Positive predictive value of S/D ratio of MCA for fetal distress was 75% where as it was 85% for DTA .
Conclusion: Doppler parameters can detect the changes of fetal hypoxia, so the mortality and Morbidity can be reduced by timely intervention.
Keywords/Observations: IUGR-intrauterine growth restriction. AEDV-absent end diastolic volume. REDV- reversed end diastolic volume. S/D ratio-systolic to diastolic ratio. PI-pulsatility index. RI-resistive index
References
- Berkowitz GS, Mehalek KE, Chitkara U et al. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynaecol 1988;71:742-746.
- Vyas S, Nicolaides KH, Bower S et al. Middle cerebral artery flow velocity waveform in fetal hypoxaemia. Br J Obstet Gynaecol 1990;97:797-803.
- Trudinger BJ, Giles WB, Cook CM. Flow velocity waveform in the maternal uteroplacental and fetal umbilical circulations. Am J Obstet Gynaecol l985;152:155-163.
- Rochelson BL, Schulman H, Fleischer A et al. The clinical significance of Doppler umbilical artery velocimetry in the small for gestational age fetus. Am J Obstet Gynaecol 1987;156:1223-1226.
- Lakhar BN, Ahmed SA. Doppler velocimetry of uterine and umbilical arteries during pregnancy. Ind J Radiol Imag 1999;9:119-125.
- KarsdorpVHM, van Vugt JMG, van Geijn HP et al. Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Lancet 1994;344:1664-1668.
- Woo JSK, Liang ST, Lo RLS et al. Middle cerebral artery Doppler flow velocity waveforms. Obstet Gynaecol 1987;70:613-616.
- Chandran R, Serra VS, Sellers SM et al. Fetal cerebral Doppler in the recognition of fetal compromise. Br J Obstet Gynaecol 1993;100:139-144.
- Mari G, Deter RL. Middle cerebral artery flow velocity waveforms in normal and small-for–gestational-age fetuses. Am J Obstet Gynaecol 1992;166:1262-1270.
- Bahlmann F, Reinhard I, Krummenauer F et al. Blood flow velocity waveform of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinat Med 2002;30:490-500.
- Weiner Z, Farmakides G, Schulman H et al. Central and peripheral hemodynamics changes in fetuses with absent end diastolic velocity in umbilical artery: correlation with computerised fetal heart rate pattern. Am J Obstet Gynaecol 1994;170:509-515.
- Forouzan I, Tian ZY. Fetal middle cerebral artery blood flow velocities in pregnancies complicated by intrauterine growth restriction and extreme abnormality in umbilical artery Doppler velocity. Am J of Perinatol 1996;13:139-142.
- Konje JC, Bell SC, Taylor DJ. Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: is the occurrence of reversal of compensatory flow too late? Br J Obstet Gynaecol 2001;108:973-979.
- Jouppila P, Kirkinen P. Increased vascular resistance in the descending aorta of the human fetus in hypoxia. Br J Obstet Gynaecol 1984;91:853-856.
Corresponding Author
Dr Vijay Thakur
Associate Professor Radio-Diagnosis, Indira Gandhi Medical College, Shimla HP India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.42
