Obstetric Doppler studies in prediction of perinatal outcome in intrauterine growth restriction

Abstract

Background: Fetal surveillance of the pregnancies that are complicated by IUGR is essential to improve fetal outcome. Colour Doppler studies of uteroplacental and fetoplacental circulation are useful in identification of hypoxemic status of the fetus and allows timely intervention in at risk fetuses. The present study was aimed to know the significance of colour Doppler studies in intrauterine growth restriction cases and to correlate with the perinatal outcome thus to offer better strategies for early diagnosis of compromised fetus and timely intervention.Methods: This was a prospective study of 125 singleton pregnancies in the third trimester with IUGR. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.Results: In the present study 63 patients had one or more adverse perinatal outcome parameter. The diagnostic accuracy of umbilical artery was more (71.20%) than other parameters in predicting adverse perinatal outcome. Middle cerebral artery RI was having highest specificity and positive predictive value of 100% than any other parameter in predicting adverse perinatal outcome. Patients with AEDF and REDF had 33.3% and 50% perinatal deaths respectively.Conclusions: Middle cerebral artery Doppler studies shown more specificity and positive predictive value than umbilical artery Doppler in prediction of adverse perinatal outcome.

Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome

“…Kumbar et al [ 6 ] evaluated the role of Doppler parameters in IUGR babies and found that 50% of perinatal deaths were seen in cases showing absent diastolic flow and 100% in cases having reverse end diastolic flow. In Gaikwad et al, 50% mortality in cases of REDF and 33.33% mortality was seen in cases with AEDF [ 3 ].…”

“…This is similar to the study of Kavitha et al out of these 15, 14 cases had adverse perinatal outcomes [ 4 ]. Gaikwad et al found adverse perinatal outcomes in 63 (50.4%) patients [ 3 ]. Out of 59 (65.6%) adverse event outcome patients, most of the patients (20/74.1%) had PE without severe features followed by eclampsia (19/79.25%), PE with severe features (13/72.2%) and GDM (7/33/3%).…”

“…Among 90 (100%) of the patients, the majority of the babies (43/47.8%) had NICU admission, about 32 (43.2%) babies had low birth weight (LBW) and 27 (36.5%) had low APGAR scores. In the Gaikwad study out of a total of 125 babies, 80.8% babies had LBW (< 2.5 kg) [ 3 ]. NICU admission was in 88.8% of babies for various reasons like LBW, asphyxia, prematurity, etc.…”

“…It was discovered that MCA RI had the highest specificity of 100% for predicting unfavorable outcomes. Additionally, MCA RI was found to have a PPV of 100% for predicting unfavorable outcomes [ 3 ].…”

“…In Gaikwad et al's study, the UA RI had a higher specificity and PPV of 91.94% and 81.48% in predicting adverse perinatal outcomes. In Gaikwad et al, the correlation between UA RI and pregnancy outcome was found statistically significant (p<0.05) [ 3 ]. Another study conducted by Lakshmi et al [ 8 ] showed that the UA RI had a sensitivity of 84.9%, specificity of 72.3%, PPV OF 77.5%, NPV OF 89%, and diagnostic accuracy of 79%, and Lakhkar et al [ 9 ] showed a sensitivity of 44.4% and specificity of 81.8% as described in Table 9 .…”