Abstract

Introduction: Intrauterine growth retardation refers to a rate of growth of a fetus that is less than normal for the growth potential of a fetus (for that particular gestational age). IUGR affects 26 % of our population and is a major concern area both for obstetrician and neonatologist. Immediate complications to a growth restricted foetus include risk of intrauterine death, perinatal asphyxia, hypoglycemia, hypothermia and risk of sepsis in the neonatal period. IUGR predisposes them to adult onset diseases like diabetes and cardiovascular diseases too. Ultrasound with doppler velocimetry of the uteroplacental and foetal circulation is used to monitor the progress of disease in these IUGR babies. In the present study, an attempt is made to establish a relationship between foetal and uteroplacental changes and perinatal outcome.

Materials and Methods: It is a prospective study done in the Dept. of obstetrics and gynecology at Govt. medical college, thiruvananthapuram.65 cases of clinically detected ultrasound confirmed cases of IUGR in third trimester were the subjects. Serial Doppler measurements of the umbilical artery, middle cerebral artery and ductus venosus were recorded till a decision for termination of pregnancy was taken. Last measurement values were taken for statistical analysis. Based on these measurements patients were classified into 4 groups.

Group 1-IUGR with normal velocimetry in all 3 vessels

Group 2-abnormal Doppler velocimetry in umbilical artery only (elevated UA pi and or s/d ratio)

Group 3—abnormal Doppler velocimetry in MCA (MCA PI & or S/D ratio < 2 SD   below the gestational age mean) in addition to abnormal UA PI with normal flow patterns in ductus venosus.

Group 4-abnormal wave forms in ductus venosus in addition to group 2&3. Pregnancy outcome including mode of delivery, gestational age at delivery, birth weight, APGAR scores, neonatal complications were recorded.

Results: 46% of subjects belonged to group1, 21% to group2, 29% to group3 and 3% to group 4.results showed that the mean gestational age at delivery of group 1 was 38.1 weeks, group2 -37 weeks, group 3 -35 weeks, and group 4- 30 weeks. (p value <.001).while considering the mode of delivery in group 1, 80 % had vaginal delivery and 20% CS.group 2 had 78% vaginal and 22 % caesarean section. Group 3 had 57% delivered vaginally and 43% by cs. In group 4, 100% cases were delivered by cs.

(p value>0.05).average birth weight in group1 -2.3 kg, group 2-1.89kg, group 3-1.69kg and group4-1.05kg (p value<0.01).

Summary and Conclusions: Doppler study of the foetoplacental circulation can accurately identify IUGR cases at risk of abnormal perinatal outcome. Normal umbilical Doppler velocimetry in IUGR effectively rules out the chance of an abnormal perinatal outcome. Cases with AEDV/REVD are associated with higher risk of perinatal morbidity and earlier deterioration of pregnancy. Abnormal ductus venous flow is a pre-terminal event and can cause rapid fetal loss if not intervened immediately.