Correlation of Middle Cerebral Artery Doppler Velocimetry and Perinatal Outcomes in Intra Uterine Growth Restricted Babies

Authors

  • Bishan Dhiman Professor and Head of Department, Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla, Himachal Pradesh, India.
  • Shriya Ganju Junior Resident, Department Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla, Himachal Pradesh, India.
  • Nishi Sood Assistant Professor, Department Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla, Himachal Pradesh, India.

Keywords:

Fetal Growth Restriction, Middle Cerebral Artery, Doppler Parameters, Perinatal Outcome

Abstract

Objective: To correlate foetal Middle Cerebral Artery (MCA) Doppler velocimetry indices in clinically diagnosed cases of Intra Uterine Growth Restriction (IUGR) with perinatal results.

Materials and Methods: This study was performed using Doppler MCA among 120 consecutive clinically suspected singleton IUGR pregnancy cases. As per the inclusion criteria, the subjects who were at 34-40 weeks of gestation were selected for the study. The mode of delivery of the participants was noted along with the adverse perinatal outcomes (if any) they had to experience, such as perinatal mortality, hypoglycaemia, asphyxia etc. Follow-up of the participants was ensured till delivery. SPSS 16.0 was used to analyse the obtained data.

Result: This study did not include 3 babies who had congenital anomalies at birth. Among these 120 women, three babies were born with congenital malformations. They were excluded from the study. In 117 study women, the Doppler revealed abnormal values of MCA PI (< 1.5), MCA S/ D ratio (< 4) and MCA RI (< 0.59) in 81 (69.2%), 69 (58.9%) and eight (6.8%) antenatal mothers respectively. Statistically significant correlations were observed with MCA PI and low birth weight (p < 0.001), MCA S/ D ratio and mode of delivery by caesarean section (p < 0.05). Among the neonates, 43 suffered from respiratory distress syndrome and hence needed admission to NICU. There were six perinatal mortalities.

Conclusion: MCA Doppler parameters offer an important non-invasive tool to assess foetal well-being in utero and can help to reduce the risk of prenatal mortality by timely intervention at delivery.

How to cite this article:
Dhiman B, Ganju S, Sood N. Correlation of Middle Cerebral Artery Doppler Velocimetry and Perinatal Outcomes in Intra Uterine Growth Restricted Babies. Int J Adv Res Gynaecol Obstet. 2023;1(2):10-17.

References

Faraci M, Renda E, Monte S, Prima FA, Valenti O, Domenico RD, Giorgio E, Hyseni E. Fetal growth restriction: current perspectives. J Prenat Med. 2011;5(2):31-3. [PubMed] [Google Scholar]

Vayssière C, Sentilhes L, Ego A, Bernard C, Cambourieu D, Flamant C, Gascoin G, Gaudineau A, Grange G, Houffin-Debarge V, Langer B, Malan V, Marcorelles P, Nizaqrd J, Perrotin F, Salomon L, Senat MV, Serry A, Tessier V, Truffert P, Tsatsaris V, Arnaud C, Carbonne B. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J ObstetGynecol Reprod Biol. 2015;193:10-8. [PubMed] [Google Scholar]

Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin Med Insights Pediatr. 2016;10:67-83. [PubMed] [Google Scholar]

Wardlaw TM; United Nations Children’s Fund, World Health Organization. Low birth weight: country, regional and global estimates. UNICEF; 2004. [Google Scholar]

de Onis M, Blössner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52:S5-15. [PubMed] [Google Scholar]

Singh M. Disorders of weight and gestation. In: Singh M, editor. In Care of the newborn. 5th ed. New Delhi; Sagar Publications; 1999. p. 224-45.

Kady SM, Gardosi J. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 2004;18(3):397-410. [PubMed] [Google Scholar]

Reed K, Droegmueller W. Intrauterine growth retardation. In: Centrullo CL, Sbarra AJ, editors. The problem-oriented medical record. New York: Pienum; 1984. p. 175-94.

Seeds JW. Impaired fetal growth: definition and clinical diagnosis. Obstet Gynecol. 1984;64(3):303-10. [PubMed] [Google Scholar]

Powers GT. Causes of intrauterine growth retardation (IUGR). Semin Roentgenol. 1982;17(3):163. [PubMed]

Arduini D, Rizzo G. Normal values of Pulsatility Index from fetal vessels: a cross-sectional study on 1556 healthy fetuses. J Perinat Med. 1990;18(3):165-72. [PubMed] [Google Scholar]

Bahlmann F, Reinhard I, Krummenauer F, Neubert S, Macchiella D, Wellek S. Blood flow velocity waveforms of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinat Med. 2002;30(6):490-501. [PubMed] [Google Scholar]

Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol. 1992;79(3):416-20. [PubMed] [Google Scholar]

Indrayan A, Satyanarayana L. Reference values in medicine and validity of diagnostic tests. Indian Pediatr. 2000;37(3):285-91. [PubMed]

SPSS Inc. SPSS for Windows. Version 16.0. Chicago: SPSS Inc.; 2007.

Malik R, Saxena A. Role of colour Doppler indices in the diagnosis of intrauterine growth retardation in high-risk pregnancies. J Obstet Gynaecol India. 2013;63(1):37- 44. [PubMed] [Google Scholar]

Geetha M, Prasad KJ. Role of colour doppler in IUGR. J Dent Med Sci. 2016;15(12): 14-7.

Vishwekar PS, Sudha RG, Jadhav A. Doppler ultrasound cerebroplacental ratio (CPR) - a better predictor of foetal outcome in clinically suspected IUGR pregnancies. J Evol Med Dent Sci. 2016;5(103):7523-6. [Google Scholar]

Sharma DD, Chandnani KC. Clinical study of IUGR cases and correlation of Doppler parameters with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2016; 5(12):4290 6. [Google Scholar]

Bora MK, Sharma K, Venkatesh BP, Shivanna U, Jayagurunathan U, Jagan VK. Role of colour and spectral doppler in the diagnosis of Intra Uterine Growth Restriction (IUGR) and its prediction of adverse perinatal outcome. Indian J Neonat Med Res. 2015;3(1):17-22. [Google Scholar]

Dhand H, Kansal HK, Dave A. Middle cerebral artery Doppler indices better predictor for fetal outcome in IUGR. J Obstet Gynaecol India. 2011;61(2):166-71. [Google Scholar]

Allam NE, Taiseer MM. Cerebro-placental doppler indices ratio and perinatal outcome among high risk pregnancy. J Am Sci. 2015;11(6):170-4.

Sparks TN, Cheng YW, McLaughlin B, Esakoff TF, Caughey AB. Fundal height: a useful screening tool for fetal growth? J Matern Fetal Neonatal Med. 2011;24(5):708- 12. [PubMed] [Google Scholar]

Khanduri S, Chhabra S, Yadav S, Sabharwal T, Chaudhary M, Usmani T, Goyal A, Sharma H. Role of color doppler flowmetry in prediction of intrauterine growth retardation in high-risk pregnancy. Cureus. 2017;9(11):e1827. [PubMed] [Google Scholar]

Bano S, Chaudhary V, Pande S, Mehta V, Sharma A. Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. Indian J Radiol Imaging. 2010;20(1):20-5.

[PubMed] [Google Scholar]

Singh S, Verma U, Shrivastava K, Khanduri S, Goel N, Zahra F, Shirivastava KL. Role of color doppler in the diagnosis of intra uterine growth restriction (IUGR). Int J Reprod Contracept Obstet Gynecol. 2013;2(4):566-72. [Google Scholar]

Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Parra S, Sanz M, Gratacos E, Figueras F. Added value of umbilical vein flow as a predictor of perinatal outcome in term small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2013;42(2):189-95. [PubMed] [Google

Scholar]

Cruz-Martinez R, Savchev S, Cruz-Lemini M, Mendez A, Gratacos E, Figueras F. Clinical utility of third-trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2015;45(3):273-8. [PubMed] [Google Scholar]

Downloads

Published

2023-07-31

Issue

Vol. 1 No. 2 (2023): International Journal of Advanced Research in Gynaecology and Obstetrics

Section

Research Article

License

Copyright (c) 2023 Author's

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

We, the undersigned, give an undertaking to the following effect with regard to our article entitled
“_______________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________” submitted for publication in (Journal title)________________________________________________ _______________________________________________________Vol.________, Year _________:-

1. The article mentioned above has not been published or submitted to or accepted for publication in any form, in any other journal.

2. We also vouchsafe that the authorship of this article will not be contested by anyone whose name(s) is/are not listed by us here.

3. I/We declare that I/We contributed significantly towards the research study i.e., (a) conception, design and/or analysis and interpretation of data and to (b) drafting the article or revising it critically for important intellectual content and on (c) final approval of the version to be published.

4. I/We hereby acknowledge ADRs conflict of interest policy requirement to scrupulously avoid direct and indirect conflicts of interest and, accordingly, hereby agree to promptly inform the editor or editor's designee of any business, commercial, or other proprietary support, relationships, or interests that I/We may have which relate directly or indirectly to the subject of the work.

5. I/We also agree to the authorship of the article in the following sequence:-

Authors' Names (in sequence) Signature of Authors
1. _____________________________________ _____________________________________
2. _____________________________________ _____________________________________
3. _____________________________________ _____________________________________
4. _____________________________________ _____________________________________
5. _____________________________________ _____________________________________
6. _____________________________________ _____________________________________
7. _____________________________________ _____________________________________
8. _____________________________________ _____________________________________

Important

(I). All the authors are required to sign independently in this form in the sequence given above. In case an author has left the institution/ country and whose whereabouts are not known, the senior author may sign on his/ her behalf taking the responsibility.

(ii). No addition/ deletion/ or any change in the sequence of the authorship will be permissible at a later stage, without valid reasons and permission of the Editor.

(iii). If the authorship is contested at any stage, the article will be either returned or will not be
processed for publication till the issue is solved.