Brajendra Nath Tripathi1 , Sandhya Pandey
BACKGROUND This study emphasizes on the importance of the arterial colour Doppler study in suspected intrauterine growth retardation (IUGR) pregnancy in third trimester to predict the perinatal outcome. The early prognosis prediction based on doppler indices and their ratios in suspected IUGR can play a great role in timely management of these pregnancies. METHODS In our prospective study of 50 antenatal patients in their third trimester, the arterial doppler study was performed on suspicion of IUGR based on biometry, oligohydramnios and grade III placenta. Patients in their third trimester with suspected IUGR were evaluated with colour doppler study of foetal middle cerebral artery and umbilical artery and their indices and ratios were studied. RESULTS The mean gestational age at the first Doppler US examination was 35.2 weeks+ 3.46 weeks (2SD). In our study, 24 foetuses had at least one abnormal outcome and remaining 26 foetuses had uneventful outcome. 60% of neonates (n=30) had birth weight of less than 2.5 Kg. There were 43 live births and 7 intra uterine deaths (IUD). 8 Neonates were admitted to NICU. 7 neonates had 5 min Apgar score of less than 7 and 12 babies were born by emergency caesarean section. Also, out of the 7 IUDs, 4 cases had reversal of diastolic flow and 3 had absent diastolic flow. The sensitivity of cerebroplacental ratio (MCA PI/UA PI Ratio) is 76.9% which is superior to that of UA PI (sensitivity 76.5%) or MCA PI (sensitivity 70.8%) alone in predicting the adverse outcome. Cerebroplacental Ratio and UA PI were almost equally specific (specificity= 91.7% and 87.9% respectively), but specificity of MCA PI was comparably low (69.2%). Also the diagnostic accuracy of cerebroplacental ratio (accuracy= 90%) was better than UA PI (accuracy= 88%) and MCA PI (accuracy= 66%) in predicting adverse outcomes. CONCLUSIONS Cerebroplacental ratio (MCA/UA PI) was most sensitive and accurate in predicting the adverse perinatal outcome in suspected IUGR pregnancies while performing arterial doppler study in third trimester. Presence of absent or reversal of diastolic flow in umbilical artery is an ominous sign.
