Role Of Doppler Studies in Evaluation Of Intrauterine Growth Restriction and Prediction Of Adverse Perinatal Outcome
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Background: Fetal growth restriction is associated with an increased risk of perinatal morbi-mortality and long-term complications; therefore, antenatal detection and surveillance with the optimization of delivery timing are necessary to improve pregnancy outcomes. Serial ultrasonography (US) for the evaluation of fetal growth and assessment of uteroplacental and fetoplacental circulation with Doppler studies are used to guide pregnancy management decisions.
Purpose: To study Doppler parameters in diagnosed intrauterine growth-restricted pregnancies and to correlate them with perinatal outcomes.
Methodology: The study included 63 pregnant patients with intrauterine growth-restricted fetuses in their third trimester who have attended OPD, got admitted to antenatal wards and labor room, and been referred to the Department of Radiodiagnosis bythe Department of Obstetrics and Gynaecology, Krishna institute of medical sciences, from January 2020 to June 2021. Doppler US evaluation was performed following a detailed clinical history, US biometry, assessment of amniotic fluid, and placental maturity.
Results: The study group was stratified into six categories based on the severity of the Doppler abnormalities and was assessed in terms of adverse perinatal outcomes. There was a significant increase in the frequency of adverse perinatal outcomes with the worsening of Doppler parameters. The positive predictive value of categories V & VI was 100% and the negative predictive value of category I was 100%. UA AEDF/REDF, DV A/R “a” wave, and UV pulsatility showed statistically significant associations with perinatal mortality. UA AEDF/REDF was more sensitive than DV A/R “a” wave and UV pulsatility in predicting perinatal mortality. However, DV A/R “a” wave was more specific than UA/AEDF/REDF and UV pulsatility in the prediction of perinatal mortality. Cases with mild Doppler abnormalities had a higher rate of adverse perinatal outcomes than those with marked Doppler abnormalities. IUGR cases with abnormal Doppler had a statistically significant higher risk of oligohydramnios than those with normal Doppler. Asymmetrical IUGR cases had a statistically significantly higher rate of adverse perinatal outcomes than symmetrical IUGR cases.
Conclusion: Multivessel Doppler ultrasonography can effectively stratify IUGR fetuses into risk-based categories and has a higher prognostic value. Therefore, rather than using a single Doppler parameter to evaluate IUGR pregnancies, multivessel Doppler parameters should be used. When it comes to predicting perinatal mortality, UA AEDF/REDF is a better screening modality as it has higher sensitivity than DV A/R “a” wave and UV pulsatility. UA AEDF/REDF, DV A/R “a” wave and UV pulsatility are all alarming signs that suggest a poor prognosis and a high death rate and therefore immediate intervention is warranted.
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