DOPPLER PREDICTION OF ADVERSE PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

Abstract

Introduction: To assess the significance of Doppler indices in umbilical artery and middle cerebral artery in pregnant women with IUGR and to correlate it with adverse perinatal outcome. Method(s): The study included 50 pregnant women in third trimester suspected of IUGR. Doppler ultrasonography of fetal MCA and umbilical artery was done. Result(s): Maternal age of 28-32 years comprised the majority of study population. (nj = 15). The maximum gestational age at which the delivery occurred was 32-36 weeks of gestation. Preclampsia with IUGR formed the majority of the study population. Out of 50 pregnancies, 10 (20%) had spontaneous onset of labour and delivered. 38% (n=18) induced for various reasons and 44% (n = 22) were taken up for caesarean section. Out of fifty pregnancies one ended up as an intrauterine death and 49 were live births. Out of these 43 babies has good outcome.6 babies had early neonatal death. Out of the 14 raised S/D ratio flow 8 had major adverse outcome that included 5 cases of septicemia and three cases of early neonatal death. Out of 2 absent diastolic flow patients, both had caesarean sections, but one baby died. Out of 4 reversed diastolic flow, one baby had IUFD, one expired on 1st postnatal day, 2 had severe sepsis but ultimately survived. Statistical analysis showed that MCA PI is the most sensitive parameter in the prediction of adverse perinatal outcome (90%), specificity being the highest for MCA/UAPI (96.6%). Positive predictive value is highest for MCA/UA PI (93.7%) and the negative predictive value highest being for the MCA PI (93.3%). Conclusion(s): The cerebro umbilical ratio has the highest sensitivity (86.6%), positive predictive value (81.2%) negative predictive value (94.1%) and highest specificity (91.4%) in the prediction of major perinatal adverse outcome. The ratio of MCA/UA PI (90%) is a better predictor of adverse outcome than PI of UA (80%) and MCA (82%) alone. Absent or reversed umbilical artery waveform is a strong and an independent predictor for adverse perinatal outcome. Hence, the use of Doppler provides information that is not readily obtained from more conventional tests of fetal well-being. It therefore has an important role to play in the management of the growth-restricted fetus.