The Prediction of Adverse Perinatal Outcomes in Intrauterine Growth Restriction using the Doppler Indices of Myocardial Performance and Aortic Isthmus

Abstract

Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, faced during daily clinical practice. Early diagnosis is of crucial importance. Aim of the work: To determine the value of the aortic isthmic flow index and the left mod-myocardial performance index [MPI] in the prediction of adverse perinatal outcomes in fetuses affected by IUGR. Patients and Methods: Forty Singleton fetuses with IUGR between 28 and 34 weeks were recruited. The left mod-MPI and the isthmic flow index [IFI] were calculated. Ultrasound indices had been correlated with perinatal outcome. Results: There was a statistically significant association between abnormal aortic isthmus diastolic flow and low 1-minute Apgar score and neonatal intensive care unit [NICU] admission. There was a statistically significant association between the left mod-MPI and the meconium stained amniotic fluid [AF], the need for Neonatal resuscitation, NICU admission, neonatal sepsis, and neonatal death. When considering cutoff value for prediction of adverse fetal outcome by Left MPI, a cutoff of 0.53 confers 85.2% sensitivity, 80% specificity, PPV 92%, NPV 66.7%, and accuracy of 83.8%. In addition, 85% of fetuses had normal Aortic isthmus [AoI] waveform [IFI type I] and 15% had abnormal AoI waveform, and there was a statistically significant association between abnormal AoI diastolic flow and each of [IFI of II, III, V], [low 1-minute Apgar score] and [NICU admission]. Conclusion: AoI IFI and left mod-MPI could be considered valuable for the assessment of chronic placental insufficiency, and play a role in prediction of adverse perinatal outcome associated with IUGR.

Study of Doppler-derived Myocardial Performance Index in Growth-restricted Fetuses as a Predictor of Adverse Perinatal Outcome

“…This was with in agreement Ali et al (15) who reported a significant variance in adverse neonatal outcome among the normal MPI group and elevated MPI with P value <0.016. These results were in accordance with those of Al Bellehy et al (23) who found a correlation among the progression of fetal compromise in IUGR and the deterioration of fetal cardiac function.…”

Role of Aortic Isthmus Doppler Ultrasound in Fetuses with Intrauterine Growth Restriction

“…Fetal adaptations to placenta deficiency and hypoxia rely heavily on the heart. Systolic and diastolic cardiac functions can be predicted by myocardial performance index (MPI) [7] .…”

“…Poor neurodevelopmental outcomes are linked to aberrant aortic isthmus (AoI) recordings. In spite of this, the sensitivity was modest, and its genuine relevance in daily clinical practice is still unclear [7] .…”