Role of Ultrasonography in Screening High Risk Mothers for Detection of IUGR

Introduction: The 10th percentile of expected foetal weight for gestational age is classified as intrauterine growth restriction (IUGR) or foetal growth restriction. IUGR occurs for a variety of reasons. Any issue with the placenta is a major contributor. Aims and objectives: 1) To determine the role of ultrasonography in screening high risk mothers for detection of IUGR. 2) To find out the impact of fetal parameters on the extent of IUGR.3) For correlation between sonographic pattern of IUGR and the birth weight. 4) For correlation between doppler parameters and perinatal outcome. Materials and methods: This is a prospective study done over a period of 2 years in Mamata General Hospital (MGH) from Oct 2017 to Oct 2019. Study included 50 pregnant women with high risk factors and clinically suspected IUGR attending for ultrasound examination were subjected to Uterine, Umbilical and Middle cerebral artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria. Results: Reverse, absence or slow end diastolic flow was considered abnormal which was seen in 33 patients. Nine patients had Absent /Reversed end diastolic flow of which, 3 patients had IUD, 4 had Still births, 2 were admitted in NICU with apgar at 1min <7. Middle cerebral artery was abnormal in 10 patients, of which 8 patients had IUGR babies with adverse perinatal outcome. MCA/UA S.D ratio, which was abnormal in 19 patients of which 16 patients had adverse perinatal outcome. Conclusion: Doppler has proven to be more sensitive than other methods of foetal monitoring in recognising fetal compromises early and assisting in the proper time of delivery. Keywords: Ultrasonography, doppler, IUGR.

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Correlation of efficacy of cerebro placental ratio with adverse perinatal outcome in clinically suspected IUGR pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181907 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1808

Author(s):

Geeta Singh ◽

Neerja Gupta ◽

Sangeeta Singhal ◽

Pramod Kishor Sharma

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Pulsatility Index ◽

Umbilical Artery ◽

Doppler Velocity ◽

Wave Form ◽

Adverse Perinatal Outcome ◽

Diastolic Flow ◽

Ultrasound Evaluation

Background: IUGR is a most common and complex problem in modern obstetrics. Most commonly use methods to assess fetal condition are BPP and NST which are not sensitive for predicting better perinatal outcome. Present study was an effort to evaluate the role of ratio of pulsatility index (PI) of middle cerebral artery and umbilical artery which is called cerebro placental ratio as the most sensitive, specific and accurate predictor of adverse perinatal outcome in clinically suspected IUGR Pregnancies.Methods: 50 clinically suspected IUGR Pregnancies attending antenatal clinics Muzaffarnagar Medical College and Hospital, Muzaffarnagar were subjected to Doppler ultrasound evaluation Doppler velocity wave form of umbilical artery and fetal middle cerebral artery were obtained. Pulsatility index ratio of MCA and umbilical artery (cerebro placental ratio) was evaluated in each case. Abnormal ratio is defined as CPR<1.08 considered as cut of value. Ratio was coo related clinically with perinatal outcome.Results: Out of 50 antenatal cases, 63% neonates had birth weight <2.5 kg. There were 6 IUD’S and 44 live births, 9 neonates were admitted to NICU, 7 neonates had 5 min. APGAR score <7 and 13 neonates were born by emergency CS. Of the 6 IUDS, 4 cases had reversal of blood flow umbilical artery and 2 cases had absent diastolic flow. In all cases of reversal Diastolic flow, IUD occurred within 7 days of diagnosis. Conclusions: CPR is the most sensitive, specific and accurate parameter in prediction of adverse perinatal outcome and thus can help in decreasing perinatal mortality.

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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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Cerebro-umbilical doppler ratio as a predictor of adverse perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200364 ◽

2020 ◽

Vol 9 (2) ◽

pp. 710

Author(s):

A. Esther Kamalarani ◽

Sheba Rosette Victor

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Intrauterine Growth Restriction ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Growth Restriction ◽

Serial Measurement ◽

Non Invasive ◽

Adverse Perinatal Outcome ◽

Timely Delivery

Background: Intrauterine growth restriction (IUGR) is defined as a subnormal bodyweight or mass in utero. Fetal Doppler studies have been identified as one of the reliable and non-invasive methods of antepartum fetal surveillance in growth-restricted fetuses to detect hypoxemia and to plan timely delivery to precede acidemia. The aim of this study is to evaluate the screening efficacy of the pulsatility indices (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and the ratio of these two indices in predicting the adverse perinatal outcome in pregnancies complicated by IUGR.Methods: In this study patients were included after diagnosed to have fetal growth restriction clinically by a disparity of four weeks or more between symphysis-fundal height and gestational age and on the serial measurement of symphysis-fundal height after 30 weeks of gestation.Results: Out of 100 patients who fulfilled the criteria for the study, only 85 patients delivered. Out of them, only 16 women (18.8%) had a ratio of <1.08 which was considered abnormal and the rest of the women (81.2%) had a ratio >1.08 which was considered normal. The specificity for the Cerebro-umbilical ratio (<1.08) to predict adverse perinatal outcome was 96% whereas that for PI of umbilical A (>1.12) was 83% and that for the PI of middle cerebral A (<1.2) was 84%. However, the sensitivities for these indices were very low.Conclusions: The ratio of the pulsatility indices of the umbilical artery and middle cerebral artery is useful to predict the adverse perinatal outcome.

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Fetal umbilical artery to middle cerebral artery doppler velocimetry ratio as a predictor for adverse perinatal outcome in high risk pregnancy

MedPulse International Journal of Gynecology ◽

10.26611/10121028 ◽

2019 ◽

Vol 12 (2) ◽

pp. 53-58

Author(s):

Sanjaya Sharma ◽

◽

Shushila Kharakwa ◽

Shruti Gupta ◽

Prakhar Mohniya ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Umbilical Artery ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Adverse Perinatal Outcome ◽

Risk Pregnancy

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Role of doppler in the middle cerebral artery in prediction of fetal distress during labor in uncomplicated pregnancies at 40 weeks and beyond

Journal of obstetrics and women s diseases ◽

10.17816/jowd69163-72 ◽

2020 ◽

Vol 69 (1) ◽

pp. 63-72

Author(s):

Nikolay N. Rukhlyada ◽

Vyacheslav M. Bolotskikh ◽

Elvira R. Semyonova ◽

Olga A. Klitsenko

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Perinatal Outcome ◽

Fetal Distress ◽

Adverse Perinatal Outcome ◽

Hypoxic Brain Damage ◽

Uncomplicated Pregnancy ◽

Cerebroplacental Ratio ◽

Hypoxic Brain

The aim of this study was to reveal correlation between Doppler in the fetal middle cerebral artery and fetal decompensation during labor in uncomplicated pregnancies at 40 weeks and beyond. We by means of ultrasound Doppler examined 260 women at 40 to 42 weeks of uncomplicated pregnancy 48 hours before delivery, with fetal condition assessed subsequently during labor and immediately after delivery. We found out that in the group of women with caesarean section caused by fetal distress during labor, pulsatility indices in the middle cerebral artery evaluated just before labor were significantly lower than in the group of women whose fetus had better condition during labor. The same trend was observed when comparing Doppler velocimetry using the fetal cerebroplacental ratio. Moreover, we identified that in the group of women with newborns having Apgar 7 and less, middle cerebral artery measured less than 48 hours before delivery were lower than in the group of women having babies in better conditions. Furthermore, as result of this study, the trigger threshold for PI was found to be 0.835, below which fetuses have adverse perinatal outcome during labor. Thus, it was shown that Doppler in the fetal middle cerebral artery in uncomplicated pregnancies at 40 weeks and beyond could predict fetal distress and avoid hypoxic brain damage to the fetus during labor.

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The study of arterial and venous Doppler in high risk pregnancies and its role in perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180904 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1116

Author(s):

S. Tabitha ◽

Madishetti Rajini

Keyword(s):

Birth Weight ◽

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Predictive Value ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Ductus Venosus ◽

Delivery Mode ◽

Care Hospital

Background: Antepartum foetal surveillance is the corner stone in the management of high risk pregnancies, aimed at reducing maternal and perinatal mortality and morbidity. This study was conducted to analyse the blood flow in umbilical artery, middle cerebral artery, umbilical vein and ductus venous using doppler ultrasound in high risk pregnancies.Methods: This was a prospective study conducted in pregnant patients with high risk factors after 28 weeks of gestation who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Hyderabad during the period from October 2013 to December 2014.Results: Patients were divided into two groups, first with normal Doppler and second with abnormal Doppler, containing 76 and 20 patients respectively. Group 2 is again 4 sub-groups according to the vessel affected. Group A included the cases with affected umbilical artery, Group B included the cases with affected middle cerebral artery, Group C included the cases with both affected umbilical artery and middle cerebral artery (UA+MCA), Group D included the Cases with the affected umbilical artery, middle cerebral artery and Ductus Venosus (UA+MCA+DV) containing 12, 2, 4 and 2 patients respectively. There were more number of emergency caesarean sections than vaginal deliveries which is statistically significant (p <0.034), there were more number of sick babies than healthy babies and there are more number of still births which is statistically significant (p <0.0001), there are more number of low birth weight babies in comparison to normal weight, which is statistically significant (p <0.0037). Distribution of cases with abnormal Doppler depending on vessel abnormality according to gestational age at the time of delivery, mode of delivery, perinatal outcome, birth weight, which was statistically significant. The sensitivity and specificity of abnormal Doppler in predicting perinatal outcome is 45% with (95% CI 26.9-64.0) and 89.5% with (95% CI 79.0-95.3) respectively. The positive predictive value is 65% with (95% CI 40.9-83.6) and negative predictive value is 78.9% with (95% CI 67.7-87.1).Conclusions: This study recommends that all high risk pregnant women should undergo serial foetal monitoring. When doppler abnormalities are detected, delivery should be conducted at a tertiary care centre where facilities for caesarean section and NICU are present.

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