Role of Doppler Study in the Evaluation of Intrauterine Growth Retardation (original) (raw)
2015, Journal of Evidence Based Medicine and Healthcare
BACKGROUND AND OBJECTIVE: Intrauterine growth retardation (IUGR) is a fetal growth disorder defined on the basis of a fetal weight below 10 th percentile for the corresponding gestational age. Our study was an effort at establishing the role of Umbilical artery (UA) and Middle cerebral artery (MCA) Doppler indices in predicting the adverse perinatal out come in clinically suspected IUGR pregnancies, and to determine the role of Doppler velocimetry in clinical management of such pregnancies. Elevation of the umbilical artery systolic/diastolic ratio or of the pulsatility index (PI); absent or reversed end-diastolic flow in the umbilical artery and decreased systolic/diastolic ratio or pulsatility index in the fetal internal carotid and middle cerebral arteries are the predictors of abnormal perinatal outcome. Our study was to evaluate the role of ratio of pulsatility index (PI) which is called as Cerebroplacental Ratio i.e. MCAPI/UAPI Doppler ratio as the most accurate predictor of adverse perinatal outcome among women with clinical suspicion of IUGR attending our (SVRR Govt.) hospital. METHODOLOGY: 50 Antenatal women attending the antenatal O.P.D who were clinically suspected as having growth retardation based on clinical history of previous child with growth retardation, signs of pallor (anaemia) and high documented Blood pressures-s/o PIH, reduced abdominal height for gestational age,were evaluated using screening ultrasound.Doppler velocity wave forms were obtained from umbilical artery and fetal middle cerebral artery from all the 50 cases. 16 cases were followed up with repeat Doppler.Pulsatility index ratio of middle cerebral artery and umbilical artery, also called as Cerebroplacental ratio was evaluated in each case. Abnormal ratio is defined as Cerebroplacental ratio <1.08 was considered as a cut off value. Ratio was calculated and correlated clinically with the perinatal outcomes-in the form of IUD's, low APGAR scores and admission into ICU. RESULTS: Out of the total 50 antenatal cases, 62% (n = 31) neonates had birth weight <2.5 kg. There were 7 intra uterine deaths and 43 live births. Of the 43 live births 8 Neonates were admitted to NICU. 7 neonates had 5 min Apgar score of less than 7 and 12 babies were born by emergency caesarian section. Of the 7 IUD's 4 cases had reversal of diastolic flow and 3 cases had absent diastolic flow in umbilical artery. In all cases with reversal of diastolic flow, IUD of the fetus occurred within one week of diagnosis. INTERPRETATION AND CONCLUSION: Based on our study and on reviewing the literature, we can conclude that Doppler ultrasound is a valuable modality in evaluating growth retardation. Cerebroplacental ratio is the most specific parameter in predicting the perinatal outcome when compared to UA PI or the MCA PI alone. Absent or reversed diastolic flow in umbilical artery is an ominous finding associated with adverse perinatal outcome and mortality. Thus the umbilical artery and middle cerebral artery Doppler studies help in the prediction of adverse perinatal outcome and management of clinically suspected IUGR.
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Middle cerebral artery Doppler indices better predictor for fetal outcome in IUGR
The Journal of Obstetrics and Gynecology of India, 2011
Objective(s) : To compare the role of middle cerebral artery and umbilical artery Doppler pulsatility indices in predicting the fetal outcome in intrauterine growth restriction. Method(s) : The prospective study was conducted on 121 subjects. They were divided into two groups. The study group (n=71) consists of high risk group of pregnant women with growth restricted fetuses. The control group (n=50) consists of pregnant women with healthy fetuses. Both the groups were evaluated by middle cerebral artery and umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Results : Mothers with abnormal velocimetry had more number of cesarean sections to prevent fetal distress than those with normal velocimetry. The subjects with high risk factors had more number of abnormal waveforms than those without high risk factors. The predictive value of Doppler P.I for detecting abnormal fetal outcome was 94% in middle cerebral artery as against 83% for umbilical artery. The sensitivity was 71% for middle cerebral artery versus 44% for umbilical artery. Conclusion : Growth restricted fetuses with normal flow velocimetry are at a lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower as compared to that of neonates with normal velocimetry. Thus middle cerebral artery doppler indices were a better predictor for fetal outcome in IUGR when compared with umbilical artery in terms of sensitivity and predictive value.
Journal of Evolution of Medical and Dental Sciences
This one-year prospective study was carried out at a tertiary care hospital in Ludhiana, Punjab, on patients visiting antenatal OPD (Outpatient Department) in the third trimester with clinical suspicion of IUGR (Intrauterine Growth Retardation) by using high resolution Doppler ultrasound scanner, Model EUB-450, Hitachi. The objective of this study was to evaluate the role of ultrasound in detection of intrauterine growth retardation and to assess and compare different parameters in order to determine best ultrasonic parameter to assess IUGR. The patients included were studied under two groups: Test group of patients suspected to have IUGR on obstetrical examination (n=75) and control group of 148 subjects showing signs of normal foetal development, i.e. not suspected to have IUGR clinically. Four parameters were taken into account namely the Abdominal Circumference (AC), ratio of AC and head circumference (HC:AC), ratio of AC and femur length (FL:AC) and umbilical artery systolic to diastolic ratio (S:D). The sensitivity of ultrasound in detecting IUGR was 86.9%. Umbilical artery flow velocimetry correctly identified 24 of 46 IUGR infants, but on no occasion did this technique detect IUGR, otherwise missed by real time sonography. The sensitivity and specificity of all the four parameters can be summarized as: AC-82.6% and 89.6%, HC: AC-50% and 86.2%, FL:AC-47.8% and 82.7% and umbilical artery S:D ratio-52.1% and 93.1%. Five patients showed absent diastolic flow and three patients showed reversal of diastolic flow. None of the fetus survived in whom there was reversal of flow. We conclude that sonography is a safe, reliable, non-invasive tool in assessment and management of suspected IUGR at or beyond 32 weeks of gestation for obstetrician and the neonatologist.
Journal of Medical Science And clinical Research
Objectives: This study was used Doppler ultrasonograpy to evaluate the abonrmalities in fetuses of women with clinical suspicion of IUGR. Methods: A detail history, clinical examination and relevant investigations were performed to all cases. Parameters was used included Doppler indices like Pulsatility Index (PI) values of the Umbilical Artery (UA), the Middle Cerebral Artery (MCA) and the descending Thoracic Aorta (TA) of the foetus and the ratio of the PI values of MCA to UA (cerebroplacental ratio). Results: Data was analyzed by using simple statistical methods with the help of MS-Office software. Conclusions: Women with less than 30 years age group was more common to develop IUGR. Majorities of women were undergone caesarean section. Changed EDF was very common in both umbilical artery and thoracic artery of foetuses. AEDF was commonly seen in umbilical artery. Majorities of babies who had MCA and UA abnormality were admitted in NICU. Majorities of cases of caesarean section had foetal distress. Perinatal death was commonly seen in foetal with MCA involvement. Hence, we were found that Doppler ultrasonography is one of the best investigative modalities to diagnose intrauterine growth retardation.
International Journal of Research in Medical Sciences, 2016
Background: Intra uterine growth restricted (IUGR) is when the expected foetal weight is less than 10 th percentile for gestational age. The hemodynamics of the feotus takes into account both the umbilical-placental and cerebral vascular beds. Underlying etiology that results in the failure of a foetus to attain its expected growth may vary. However the final infliction is via uteroplacental insufficiency. It is highlighted that inadequate uteroplacental perfusion is the main and primary pathology in growth restriction resulting in an increased umbilical artery impedance. Following this step are the changes in the middle cerebral artery (MCA) which categorically set in as a secondary phenomenon. Methods: Duplex Doppler Sonography is a reliable, non-invasive and rapid diagnostic technique in IUGR patients. Grey scale findings together with colour Doppler characteristics help in the qualitative as well as quantitative evaluation of the Uteroplacental and Fetoplacental circulation. Hence ultrasonography (USG) has become the most widely used, standard and simple way of detecting and confirming IUGR. Ultrasound biometry is the gold standard for assessment of foetal size. Various criteria are used to label a feotus growth restricted; foetal weight less than 10th percentile for gestational age is mostly widely accepted criterion. Others like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. After establishing the diagnosis of IUGR, Doppler imaging becomes a valuable investigating method for monitoring the pregnancy because it provides information about the hemodynamic status of the feotus. Uteroplacental system evaluation takes into account the flow pattern of uterine artery, reflecting any underlying Uteroplacental vascular ischemia. Umbilical artery Doppler waveforms reflect the status of the fetoplacental circulation and any underlying placental insufficiency. Results: Fourteen cases showed absent umbilical artery end diastolic flow and four patients showed reversal of end diastolic flow.: Twenty two patients showed elevated PI. Adverse perinatal outcome was observed in all patients with absent and reversal of end diastolic flow. Out of the twenty two with elevated PI fifteen showed adverse outcome. Thirty six cases showed low MCA PI and six showed a pseudonormalization. A cerebro-placental ratio of < 1.08 was observed in 16 patients, it was calculated in only those pregnancies that showed forward diastolic flow in umbilical artery (n= 22). Fifteen of them showed adverse perinatal outcome. Conclusions: Doppler imaging is of value for monitoring pregnancies complicated with IUGR because it can provide indirect evidence of foetal compromise and is known to improve outcome of high risk pregnancies. Doppler evaluation is complementary to all other surveillance modalities. Because the changes in umbilical, uterine & MCA strongly correlate with pregnancy outcome in growth restricted foetuses the use of foetal biometry & Doppler examination is recommended in all cases of suspected IUGR cases.
2014
BACKGROUND Intrauterine growth restriction /retardation (IUGR) is defined as birth weight below the 10th percentile for a given gestational age. Placental insufficiency is the primary cause of intrauterine growth retardation in normally formed fetuses and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to compare perinatal outcome in growth restricted fetuses retaining normal umbilical artery Doppler flow to those with diminished or severely reduced/absent end-diastolic flow. METHODS This cross sectional study was conducted at Radiology department of Pakistan Navy Ship (PNS) Shifa Hospital, Karachi over one year period from. Established cases of asymmetrical IUGR, having estimated fetal weight < 10th percentile for gestational age and between 28-40 weeks of gestation were included in the study. Pulsatility index (PI) was calculated for each case. Perinatal outcomes like early delivery, caesarean secti...
Role of venous Doppler evaluation of intrauterine growth retardation
The Egyptian Journal of Radiology and Nuclear Medicine, 2015
Aim of the work: The aim of this work is to determine the role of venous Doppler Ultrasonography for the prediction of adverse perinatal outcome in ''intrauterine growth restricted fetus'', providing the obstetrician with additional information about the time frame and significance of the IUGR to help determine the optimal time of delivery. Patients and methods: Sixty pregnant females with their age ranging between 28 and 35 years, gestational age between 27 and 37 weeks of gestation were enrolled in the study. All patients in the study were subjected to Doppler examination of the umbilical vein (UV), Ductus venosus (DV), right hepatic vein (HV) and umbilical artery (UA). Results: Abnormal UA Doppler was found in 40 patients. Abnormal DV Doppler was found in 40 patients. Abnormal UV Doppler was found in 10 patients. Abnormal Rt. HV Doppler was found in 20 patients. All parameters studied were strongly related to perinatal mortality, however, none had 100% sensitivity, the pulsatility index in the Rt. HV and DV were the best single indices to use in the prediction of perinatal mortality. Conclusion: We observed that venous Doppler is superior to arterial Doppler in predicting poor perinatal outcome and that the abnormal equivocal BPP scoring significantly correlated with adverse outcome. We also, concluded that multi-vessel Doppler Ultrasonography and BPP can Abbreviations: UV, umbilical vein; DV, Ductus venosus; HV, hepatic vein; UA, umbilical artery; PI, pulsatility index; IUGR, intrauterine growth retardation; EDV, end diastolic velocity; RF, reversed flow; AEDF, absent end diastolic flow; REDF, reversed end diastolic flow; FGR, fetal growth restriction; A/R, absent or reversed flow; pH, power of hydrogen; BPP, biophysical profile effectively stratify IUGR fetuses with placental vascular insufficiency into risk categories. Fetal deterioration appears to be independently reflected in these two testing modalities; their combined use is likely to be complementary.
International Journal of Medical Arts
Background: Disorders related to intra-uterine fetal growth usually had different perinatal morbidity and mortality. Accurate diagnosis of intrauterine fetal growth is a challenging difficult task, but recent technological advances are associated with significant improvements with positive impact on antenatal care. Aim of the work: The aim of this study was to evaluate the accuracy of the umbilical and middle cerebral artery Doppler indices [e.g. resistance index] in prediction of fetal outcome in pregnancies with intra-uterine growth restriction (IUGR). Patients and Methods: Forty-five pregnant females had been included in a prospective study. All had a confirmed diagnosis of IUGR. Doppler ultrasound used to record fetal middle cerebral artery [MCA] and umbilical and Doppler indices every one week (from 32 weeks onwards). Post-delivery birth weight, Apgar score at 0 and 5 minutes had been measured and correlated with Doppler indices. Results: One-fifth of the mothers participating in the study (20%) had pre-term birth and 6.7% missed the follow-up. Umbilical artery resistance index (RI) at a cut off value of (0.79) had a diagnostic accuracy of 93%. MCA RI best cut off value was 0.63 with diagnostic accuracy of 73.9%. Also, for C/U ratio had diagnostic accuracy of 92.9%. Finally, there was significant, proportional correlation between MCA RA and C/U ratio from one side and APGAR score at 0 and 5 minutes from the other side. However, the correlation between UARI and Apgar score was inverse and statistically significant. Conclusion: Doppler velocimetry of fetal circulation can provide important information regarding fetal well-being, with subsequent impact on fetal outcome.
Journal of Clinical Ultrasound, 2014
Background. To evaluate the role of umbilical artery (UA) peak systolic velocity (PSV) measurements in the prediction of perinatal outcome in fetuses with intrauterine growth restriction (IUGR). Methods. A prospective study was performed, including patients with a suspected diagnosis of IUGR. Exclusion criteria were multiple gestations, unreliable gestational age, and known fetal malformations. Doppler measurements of the UA and middle cerebral artery (MCA) were recorded. Results. Seventy-two patients were enrolled and a total of 192 Doppler measurements were performed between 24 and 39 weeks' gestation. Mean gestational age at delivery was 36.9 6 2.7 days and mean birth weight was 2,166 6 497 grams. Nine patients (12.5%) had oligohydramnios; 50 (69.4%) delivered preterm (<37 weeks), and 26 underwent a cesarean section, of those 7 (29.2%) cesarean sections were for a nonreassuring fetal heart rate tracing. Fifty-one (70.8%) neonates were actually small for gestational age. No correlation was found between UA-PSV and MCA-PSV to perinatal outcome. Correlation was found between UA pulsatility index and cerebroplacental ratio to perinatal outcome before 34 weeks' gestation. Conclusions. UA PSV measurements do not correlate with adverse perinatal outcome. A correlation exists between UA pulsatility index and cerebroplacental ratio and perinatal outcome prior to 34 weeks' gestation. It seems that UA PSV and MCA PSV do not contribute to the management of fetuses with IUGR.
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