Comparison of Diagnostic Efficacy of Umbilical Artery and Middle Cerebral Artery Waveform with Color Doppler Study for Detection of Intrauterine Growth Restriction Fetuses
Journal Title: ​International Journal of Contemporary Medicine surgery and Radiology - Year 2017, Vol 2, Issue 2
Abstract
Introduction: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality, morbidity, and impaired neurodevelopment. This prospective study was performed to determine the degree of neonatal morbidity in fetuses suspected of having intrauterine growth restriction (IUGR) by doppler ultra sound. Material and Methods: Present study included a total number of 50 cases.Doppler US evaluation was performed following a detailed clinical history, US biometry, and assessment of amniotic fluid and placental maturity. Follow up Doppler studies were performed if clinically indicated to determine a favourable or a worsening trend in the Doppler indices. However only the results of the first Doppler ultrasound were used for analysis of perinatal out come. Results: Among 50 pregnancies with clinical suspicion of IUGR Mean birth weight at delivery was 2.43kg +/- 0.26 kg (2SD). 60% of neonates (n=30) had birth weight of less than 2.5 kg. 48% (n=24) fetuses had at least one adverse outcome; some of them (n=8) had more than one adverse outcome. Remaining 26 fetuses had favorable outcome. 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. MCA/UA pulsatility index ratio had a higher Sensitivity, Positive predictive value for adverse perinatal outcome than did the MCA pulsatility index and the UA PI. It was found that MCA PI had low specificity in predicting adverse outcome. There were 7 IUDs in whom 4 cases had reversal of diastolic flow and 3 had absent diastolic flow. In all cases with reversal of diastolic flow IUD occured with in one week of diagnosis. And all the 4 cases were less than 32 weeks. In our study Mortality in case of Reversed end diastolic flow was 100% and 33% in absent diastolic flow indicating grave prognosis. Conclusions: In fetuses with suspected IUGR, abnormal MCA/UA S/D ratios are strongly associated with low gestational age at delivery, low birth weight, and low UA pH. Abnormal MCA/UA S/D ratios are also significantly associated with shorter interval to delivery and the need for emergent delivery.
Authors and Affiliations
T. Munikumari, Vadlamudi Vijetha, N. V. Sree Divya
Keywords
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