Perinatal Outcome of Growth Restricted Fetuses with Abnormal Umbilical Artery Doppler waveform compared to Growth Restricted Fetuses with Normal Umbilical Artery Doppler Wave forms at a tertiary referral hospital in urban Ethiopia

Abstract

Background: Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia.Methods: A comparative prospective cohort study was conducted among pregnant mothers complicated with intrauterine growth restriction (IUGR) admitted to labor and delivery room for pregnancy termination during from September 2018-February 2019. Two midwives collected the data using a structured and pretested questionnaire. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data and checking for, statistical associations between abnormal umbilical artery doppler and outcome variables, binary logistic regression was conducted to control for confounders.Results: A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery doppler studies and 37 were with abnormal umbilical artery doppler studies. On the 7th neonatal day, 129(97%) of normal and 29(78.4%) of abnormal umbilical artery doppler were alive whereas 4(3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in early neonatal death. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery doppler study neonates required neonatal intensive care admission. Growth restricted fetuses complicated with abnormal doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery doppler flow, P-value 0.002, (OR=2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery doppler flow, P-value 0.001, (OR=4.136, 95%CI 3.423-4.998).Conclusion: The abnormal umbilical artery doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia and early neonatal death. Growth restricted fetus with abnormal umbilical artery born at gestational age less than 34 weeks were more likely to require NICU admission, develop respiratory distress syndrome and end in early neonatal death. Growth restricted fetuses complicated with abnormal umbilical artery doppler waveform should undergo umbilical vein and ductus venous doppler studies to prevent preterm delivery based on umbilical artery doppler study finding alone.