Prediction of perinatal outcome with umbilical artery Doppler in IUGR fetuses- a prospective analytical study in a tertiary medical college in Tamilnadu, India

Background: Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight alone in intrauterine growth restricted (IUGR) fetuses. Perinatal mortality and morbidity are increased if the umbilical artery Doppler abnormality worsens.Methods: This study was conducted in Department of Obstetrics and Gynaecology, Thanjavur medical college from August 2015 to August 2016. One hundred singleton pregnancies complicated by IUGR beyond 32 weeks were subjected for Doppler study of umbilical artery. Perinatal outcome in terms of baby outcome, birth weight, early neonatal death, admission in NICU and duration of admission in NICU were analysed.Results: The main indication of termination of pregnancy was oligohydramnios (70%). The other causes of termination were 8% for uncontrolled hypertension and 4 % for post term. 60 % were delivered vaginally and 40% by lower segment cesarean section. Various indication for LSCS were Non-reactive CTG, fetal distress, severe oligohydramnios and failed induction. 92% were delivered alive babies and 8% still born babies. Birth weight of the babies varied from 900gm to 2.5Kg. But patients with absent or reversed end diastolic flow in umbilical artery Doppler, 80% of the babies weighed less than 1.5Kg. Perinatal mortality in our study is 19% which includes 8% of intrapartum mortality and 11% of neonatal mortality and perinatal morbidity is 24%. When the diastolic flow in the umbilical artery is, absent or reversed, it is associated with increased perinatal mortality of 80%.Conclusions: The results of present study clearly demonstrated the efficacy of umbilical artery Doppler in predicting the fetal outcome. To improve the predictive value of this tool, a better method is needed to assess the wellbeing of the IUGR fetuses such as integrated antenatal test which combines BPP and Doppler study employing other vessels.

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Role of Umbilical and Middle Cerebral Artery Doppler in Predicting Perinatal Outcome in Cases of Preeclampsia

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/37 ◽

2021 ◽

Vol 8 (04) ◽

pp. 195-198

Author(s):

Kitty Elizabeth Mammen

Keyword(s):

Blood Flow ◽

Birth Weight ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Neonatal Death ◽

Umbilical Artery ◽

Diastolic Flow ◽

Umbilical Artery Doppler

BACKGROUND One of the most common complications of pregnancy is preeclampsia, characterized by abnormal placental development, leading to inadequate uteroplacental blood flow. Doppler ultrasonography can pick up these abnormalities; thus, it is a useful tool to assess fetal outcome. Objective is to calculate the role of colour Doppler (umbilical and middle cerebral artery) in predicting the perinatal outcome. We wanted to evaluate the application of Doppler ultrasound in analysing the blood flow velocity waveform. METHODS This was a cross sectional study carried out between May 2010 - November 2012 in Obstetrics Department, Yenepoya Medical College, Karnataka, among 150 pregnant women with preeclampsia. RESULTS 49.3 % of patients belonged to 25 - 30 years, 58.7 % were primigravida, and 73.3 % and 26.7 % had mild and severe preeclampsia respectively. Patients with increased resistance umbilical artery Doppler - 63.8 % had babies < 2.5 Kg birth weight, 60.9 % Apgar < 7 at 5 minutes of birth and 67.5 % neonatal intensive care unit (NICU) admissions; absent end diastolic flow - all had birth weight < 2 Kg, 90 % Apgar < 7 at 5 minutes, 1 neonatal death and all required NICU admissions; reversal end diastolic flow - 1 neonatal death, all had birth weight < 2.5 Kg, an Apgar < 7 at 5 minutes and required NICU admission. Patients with abnormal Doppler in middle cerebral artery, 46.2 % were low birth weight and had Apgar < 7 at 5 minutes, 50 % required NICU admissions, but no perinatal mortality. CONCLUSIONS Doppler analysis helps in early detection of uteroplacental and fetoplacental changes and to take decisions for early interventions, like administration of steroids for fetal lung maturity and transferring preterm pregnancies to higher centres for better NICU facilities. Umbilical artery Doppler findings are slightly better predictors of adverse perinatal outcome than an abnormal middle cerebral artery. KEYWORDS Doppler, Preeclampsia, Perinatal Outcome, Umbilical Artery, Middle Cerebral Artery

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