Bindu Philip 1 , Shirly Kurian
BACKGROUND The condition in which the foetus does not reach its growth potential is called Intrauterine Growth Restricted (IUGR). The mothers who are generally healthy and well nourished, the incidence of IUGR is 3-5%. The incidence of IUGR is 15-20% or higher in a women population with hypertension or previous growth restricted foetus. The aim of the study is to assess foetal compromise by Doppler ultrasound investigation of the foetal circulation. MATERIALS AND METHODS This study is a prospective study conducted between November 2013 to November 2016 in the Department of Radiodiagnosis and imaging of Mount Zion Medical College, Kerala. A total of 50 singleton pregnancies with suspected IUGR pregnancy attending the outpatient ward of Obstetrics and Gynaecology. Inclusion Criteria- Pregnancies from 29 weeks to 42 weeks of gestation complicated by intrauterine growth restriction and who are ultrasound confirmed. In the first trimester, gestational age determination was estimated by history of menstruation or biometry of foetus. Exclusion Criteria- Patients who had multiple gestations, congenital anomalies and history of membranes rupture. All the patients in the study were subjected to clinical history in detail to assess the risk factors of IUGR pregnancy, biometry of ultrasound and amniotic fluid assessment followed by Doppler ultrasound evaluation of uterine arteries, umbilical artery, middle cerebral artery, descending foetal thoracic aorta, ductus venous and umbilical vein. RESULTS Majority of the patients were in the age group of 21-24 years. All the patients were in the age group of 19-30 years. 45% of antenatal mothers examined were between 28-31 weeks of gestational age, 35% were between 32-36 weeks of gestation, 20% were between 37-42 weeks of gestation age. 15 antenatal mothers had elevated uterine artery resistance index (30%), 12 antenatal mothers had persistent early diagnostic notch (24%), 11 antenatal mothers had elevated systolic/diastolic ratio (22%), 12 antenatal mothers had elevated uterine artery pulsatility index (24%), 15 antenatal mothers had elevated umbilical artery pulsatility index (30%), 10 antenatal mothers had elevated resistance index (20%) and 25 antenatal mothers had elevated systolic/diastolic ratio (50%). 8 (16%) foetus showed absence of end-diastolic flow in the umbilical artery flow velocity and 2 (4%) had reversal of end-diastolic flow in the umbilical artery flow velocity with a total of 10 (20%) foetuses having abnormal waveforms. There were 5 cases of intrauterine deaths, out of which 3 had absence of diastolic flow and 2 had reverse diastolic flow. Decreased pulsatility index of foetal middle cerebral artery was in 22 (44%) foetus, normal pulsatility index of foetal middle cerebral artery was in 28 (56%) foetuses. Elevated pulsatility index of descending thoracic aorta was in 26 (52%) foetuses, normal pulsatility index of descending thoracic aorta was in 24 (48%) of foetuses. Umbilical vein and ductus venous Doppler study showed that 20 (40%) of the foetuses had presence of pulsatile flow in the umbilical vein flow velocity waveform and 30 (60%) showed absence of pulsatile flow. There were 5 intrauterine deaths and 45 livebirths. Of the 45 livebirths, 10 neonates were admitted in ICU, 10 neonates had 5 mins. Apgar score of less than 7. 11 foetuses had at least one adverse perinatal outcome, remaining 14 foetuses had favourable conditions. CONCLUSION After changes in arteries, early changes in veins is observed, which results in poor perinatal outcomes with increased risk of foetal mortality. Hence, Doppler investigation of the foetal venous circulation play an important role in monitoring the redistributing growth retarded foetus and thereby may help to determine the optimal time for delivery
