Role of Colour Doppler Indices in the Diagnosis of Intrauterine Growth Retardation in High-Risk Pregnancies

Abstract

Purpose Intra uterine growth retardation (IUGR) due to fetoplacental vascular insufficiency is rampant in developing countries like India. Owing to the lack of awareness, antenatal patients often present in their third trimester for their first ultrasound examination. Alterations in the waveforms and Doppler indices of fetal middle cerebral artery (MCA), umbilical artery and bilateral uterine arteries have been extensively described in various studies in the literature. However, the role of each doppler parameter in actually predicting reduced birth weight (for gestational age) in the third trimester is often debatable and frustrating. Method A prospective study was done on 100 patients of clinically suspected IUGR/high-risk pregnancies of 31-41 weeks. The cases were followed till delivery; the doppler and grey scale findings were correlated with the birth weight of the baby. Result The highest sensitivity was found to be of HC/AC ratio, (84.4 %), the highest specificity of oligohydramnios and Cerebral/Umbilical Pulsatility ratio[C/U ratio] (100 %). The sensitivity of C/U ratio was found to be 68.8 %. Fetal MCA had the lowest sensitivity (7.7 %). Conclusion HC/AC ratio is quite sensitive, and oligohydramnios is a highly specific parameter to diagnose IUGR. However, the former has lower specificity, and the latter has very poor sensitivity. The MCA PI alone is not sensitive at all, and should not be used for screening purposes in IUGR patients. Also, C/U ratio is more sensitive than oligohydramnios and more specific than HC/AC ratio and stands out as the best parameter of all to diagnose IUGR in the third trimester.

Umbilical Artery Doppler Velocimetry and Its Relation to Perinatal Outcome in Normal and High-Risk Pregnancies

“…Then transducer was placed over anterior abdominal wall over the uterus and was carefully manipulated till a free loop of umbilical cord seen by Grey scale imaging and colour was used to identify the umbilical artery. [6] Waveforms of Doppler ultrasound obtained for umbilical artery was collected and following indices were measured viz. Peak Systolic/diastolic ratio (S/D ratio) and Resistance Index (RI) = Peak systolic flow-diastolic flow/ peak systolic flow.…”

Restricción del crecimiento intrauterino: una aproximación al diagnóstico, seguimiento y manejo

“…La sensibilidad de la evaluación de las arterias uterinas para la identificación de resultados adversos es de 37,7% con especificidad de 70%, valor predictivo positivo de 91,8 y valor predictivo negativo de 11,1% (39).…”

“…En un embarazo normal se observa baja resistencia en el flujo feto-placentario y en gestaciones complicadas con RCIU se evidencian velocidades anormales en el flujo diastólico que se encuentran en relación con pobres pronósticos perinatales, principalmente el flujo reverso que puede presentarse cuando el lecho capilar placentario se encuentra reducido en más del 50% (13). La sensibilidad de la medición de los índices de arteria umbilical para identificación de resultados fetales adversos es de 64,4% con una especificidad de 80%, valor predictivo positivo de 96,6% y valor predictivo negativo de 20% (39).…”

Doppler velocimetry of umbilical, and middle cerebral arteries in the prediction of fetal outcome

“…1 It is a noninvasive method for assessing fetal circulation. Its indices provide important information on the hemodynamics of the vascularity of fetal vessels.…”

“…Doppler study gives valuable information about hemodyanamic situation of the fetus and is an efficient diagnostic test of fetal jeopardy that helps in the management of high risk pregnancy. 1 Upto 16 weeks of gestation, an early diastolic notch is usually present in the utrine artery. Abnormalities in utrine artery Doppler are the presence of diastolic notch in the second trimester.…”