Doppler changes in iugr pregnancy following maternal corticosteroids: A prospective observational analysis at a tertiary care hospital

Abstract

Aims and objectives: To evaluate the impact of maternal administration of betamethsone on fetoplacental and uterine circulation in preterm pregnancies complicated with intrauterine growth restriction. Materials and methods: Prospective observational study included 77 preterm pregnant women from 26-to 34-week period of gestation with IUGR. Color Doppler blood flow study (day 0) of fetoplacental and maternal circulation including umbilical artery middle cerebral artery (MCA), ductus venosus, maternal uterine arteries of all cases was being done. After day 0 Doppler, all received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Repeat Doppler (day 2) of the above-mentioned vessels was performed between 24 hours and 48 hours of first dose of betamethasone of all cases, and various indices were recorded. Third Doppler examination (day 4) of umbilical artery and MCA was done between 72 hours and 96 hours of first dose of betamethasone administration of all women (60 cases), and then Doppler indices values on day 4 were noted. Tabulated data were analyzed statistically by using appropriate statistical tests such as paired t-test, Pearson’s Chi-square test, and ANOVA. Results: A significant reduction in mean umbilical artery pulsatility index (PI) and S/D ratio was observed on day 2 following betamethasone administration (p <0.001), which was maintained till fourth day after first dose of betamethasone (p <0.05). A significant reduction in mean MCA PI and S/D ratio was obtained on day 2 following betamethasone administration (p <0.001) but the effect was transient and became insignificant by day 4. A significant decrease in mean ductus venosus PI was observed on day 2 following betamethasone administration (p <0.05). No significant change of maternal betamethasone administration in maternal uterine artery PI was observed (p >0.05). Conclusion: Fetoplacental circulation of pregnancies with intrauterine growth restriction showed divergent response in terms of changes in various fetoplacental Doppler indices following antenatal betamethasone administration. Clinical significance: This offers a unique model to explore the regulation of the fetoplacental vasculature. These findings are also important for fetal surveillance undertaken following corticosteroid administration to pregnant women with IUGR.