Doppler patterns in growth restricted foetuses: determinants and outcome in a tertiary hospital in South Kerala, India

Abstract

Background: Foetal growth restriction refers to a condition in which the foetus is unable to achieve its genetically determined growth potential. Doppler velocimetry in FGR not only decides the optimum time of delivery but also the optimum mode of delivery and so authors evaluated the Doppler patterns in growth restricted fetuses.Methods: Nested case-control study conducted among normal and abnormal Doppler groups at a tertiary care teaching hospital in the year 2017.Results: Among 82 growth restricted foetuses, 54 of them had normal Doppler patterns (65.85%) and 28 had abnormal Doppler patterns (34.15%).13(46.5%) had umbilical S/D elevation,2 (7.14%) had AEDV,1(3.57%) with REDV and 12 (42.8%) with CPR<1. Mean maternal age was slightly higher in the abnormal Doppler group. FGR babies with abnormal velocity waveforms had shorter diagnosis to delivery interval than those with normal Doppler and decision for delivery was taken at a lower gestational age. (p value-0.001). Mothers of FGR babies with abnormal Doppler studies underwent emergency caesarean section for non-reassuring foetal heart patterns. (p value-0.001) The mean birth weight was higher (2201.80gm) in Doppler normal FGR and it was 1929.46grams in abnormal umbilical Doppler group and 1363.33gm in AREDV (pvalue-0.001). Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Growth restricted foetuses with normal umbilical velocimetry are at a lower risk than those with abnormal velocimetry in terms of prolonged diagnosis-delivery interval and shorter NICU days. The need for neonatal resuscitation at birth was more in babies with abnormal Doppler velocimetry and absent diastole /reversed diastolic flow of umbilical artery velocimetry.

Assessment of Postpartum Depression in a Tertiary Care Institute

“…Irregular antenatal care received and antenatal complications such as preeclampsia, prematurity, fetal growth restriction, and abruptio placentae do affect the mental health of postpartum patients (28.2% in both immediate and 6 months postpartum). This was supported by other studies as well [9,11,12].…”

“…Strong preference for a son has been reported in most of the studies as a cause of depression, but in our studies, no effect of gender was seen on EPDS score [7,[9][10][11][12]. Neonatal death is another significant risk factor for the development of PPD, as seen in our study and other studies as well [5,11].…”

“…Breastfeeding does not affect PPD as in our study rather, it ameliorates the effect of emotional disturbance [6,13]. Postpartum depression develops in patients who do not have good relations with their husbands, parents, and parents-in-law as they may not be getting any physical, mental, or emotional support in bringing up the baby [1,[5][6][7]9,11,12].…”

A Retrospective Record-Based Study to Identify the Indications and Outcomes of Obstetric Referrals to A Tertiary Care Centre in Gujarat, India

“…The referral hospital had successfully delivered 98% of the babies of referred mothers. 98% of the babies in the present study had live births as compared to other similar studies by Shenoy HT et al 20 (85%) and Devineni et al 21 (78%). The stillbirth rate in the present study was 0.4% which was much less than studies from West Bengal (5%) 8 or Mumbai (4.9%) 22 suggesting excellent delivery services by the teaching hospital.…”

“…In other similar studies, the NICU admission rates of babies born to referred mothers ranged from 15% to 30% 8,21-23 and perinatal mortality rates ranged from 5% to 40%. 20,21,23 (Table 4) This indicates the quality of Maternal and child care services provided at the concerned referral centre.…”