Santanu Das, Sukharanjan Howlader
BACKGROUND During pregnancy, the uterine artery represents the major portion of the anterior division of the internal iliac artery. The diastolic component of the uterine artery Doppler wave form is thus transformed during normal pregnancy from one of low peak flow velocity and an early diastolic notch by 18-22 weeks (wks.). Where there is impaired placentation, the average resistance index in the left and right uterine artery is increases and is associated with an early diastolic notch. If this notch persists beyond 24 wks. of gestation, this indicate a severe adverse outcome defined by intra uterine growth restriction (IUGR) and foetal asphyxia that may be followed by pre-eclampsia and foetal death. We investigated the prognostic value of uterine artery Doppler examination in prediction of foetal intrauterine growth. Aims and Objectives- The objectives of this study were to recognise IUGR by screening of placental insufficiency by uterine artery Doppler, and to confirm the clinical diagnosis of IUGR for the better management of pregnant mothers. MATERIALS AND METHODS Pregnant mothers, both normotensive and hypertensive were taken from antenatal OPD of R. G. Kar. Medical College & Hospital. Pregnancies with multiple gestations, congenital anomalies and preterm deliveries were excluded from the study. This is a two-stage screening test of uterine arteries by pulsed wave Doppler one at 14-18 wks. and further at 26-28 wks. of gestation. An early diastolic notch was also carefully observed in the wave of both uterine arteries. Mothers were followed up to delivery for observing foetal intrauterine growth restriction and measuring the birth weight of all babies. Sensitivity, specificity, positive predictive value (PPV) & negative predictive value (NPV) of IUGR were calculated according to the resistance index. RESULTS In our study there were 40% primigravida’s and 60% multigravidas. The sensitivity, specificity, PPV and NPV of IUGR are 45.5%, 94.8%, 71.4% and 88.3% respectively. CONCLUSION Women with an early diastolic notch after 24 wks. of pregnancy have considerably a higher risk of developing IUGR. Increased impedance to flow in the uterine arteries is associated with increased risk for subsequent development of IUGR.
