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

Middle Cerebral Artery Doppler Velocimetry and Perinatal Outcomes in IUGR

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 outcomes.


Materials and Methods: A Doppler MCA study was carried in 120 consecutive clinically suspected cases of singleton IUGR pregnancies at 34-40 weeks of gestation and were followed up until delivery. The mode of delivery and any adverse perinatal outcome; asphyxia, hypoglycemia, perinatal death or stay in Neonatal Intensive Care Unit (NICU) was recorded. The data was analyzed using Statistical Package for Social Sciences version 16.0.


Result: Among these 120 women, three babies were born with congenital malformations were excluded from the study. In 117 study women, the Doppler revealed abnormal MCA PI (<1.5), abnormal MCA S/ D ratio (<4) and abnormal 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). Forty-three neonates required admission to NICU, the main cause being respiratory distress syndrome (49%) and there were six perinatal mortalities.


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

Author Biographies

Bishan Dhiman, Professor and Head of Department Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla, Himachal Pradesh, India.

Head of the Department, Department of Gynaecology and Obstretics

Nishi Sood, Assistant Professor, Department Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla, Himachal Pradesh, India.

Assistant Professor, Department of Gynacology and Obstetrics

References

Faraci M, Renda E, Monte S et al. Fetal growth restriction: current perspectives. Journal of Prenatal

Medicine 2011; 5(2): 31-33.

Vayssière C, Sentilhes L, Ego A et al. Fetal growth restriction and intra-uterine growth restriction:

guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet

Gynecol Reprod Biol 2015; 193: 10-18.

Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med

Insights Pediatr 2016; 10: 67-83.

United Nations Children’s Fund and World Health Organization. Low Birth weight: Country, regional and

global estimates. USA, New York. 2004.

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.

Singh M. Disorders of weight and gestation. In: Singh M, ed. In Care of the New born. 5th ed. Sagar Publications, New Delhi. 1999: 224-245.

Kady S, Gardosi J. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2004;

(3): 397-410.

Reed K, Droegmueller W. Intrauterine growth retardation. In: Centrullo CL, Sbarra AJ, eds. The problem-oriented medical record. Pienum, New York. 1984: 175-194.

Seeds JW. Impaired fetal growth: definition and clinical diagnosis. Obstet Gynecol 1984; 64: 303-310.

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

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): 165-172.

Bahlmann F. 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.

Gramellini D, Folli MC, Raboni S et al. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal

outcome. Obstet Gynecol 1992; 79(3): 416-420.

Indrayan A, Satyanarayana L. Reference values in medicine and validity of diagnostic tests. Indian

Pediatrics 2000; 37: 285-91.

SPSS Inc. SPSS for Windows, Version 16.0. SPSS Inc., Chicago. 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 2012; 63(1): 37-44.

Geetha M, Prasad KJ. Role of colour doppler in IUGR. Journal of Dental and Medical Sciences 2016; 15(12):

-17.

Vishwekar PS, Rani SG, Jadhav A. Doppler ultrasound cerebroplacental ratio (CPR) - A better predictor of

fetal outcome in clinically suspected IUGR pregnancies. J. Evolution Med Dent Sci 2016; 5(103): 7523-7526.

Sharma DD, Chandani CK. Clinical study of IUGR cases and correlation of Doppler parameters with perinatal

outcome. Int J Reprod Contracept Obstet Gynecol 2016; 5(12): 4290-4296.

Bora MK. Role of colour and spectral doppler in the diagnosis of Intra Uterine Growth Restriction (IUGR)

and its prediction of adverse perinatal outcome. Indian Journal of Neonatal Medicine and Research 2015;

(1): 17-22.

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): 166-171.

Allam, Nahed E, Maarouf Taiseer M. Cerebro-placental doppler indices ratio and perinatal outcome among

high risk pregnancy. J Am Sci 2015; 11(6): 170-174.

Sparks TN, Cheng YW, McLaughlin B et al. Fundal height: a useful screening tool for fetal growth? The Journal

of Maternal-Fetal & Neonatal Medicine 2011; 24(5): 708-712.

Khanduri S, Chhabra S, Yadav S et al. Role of color doppler flowmetry in prediction of intrauterine growth

retardation in high-risk pregnancy. Cureus 2017; 9(11): e1827.

Bano S, Chaudhary VS, Pande S et al. 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): 20-25.

Singh S, Verma U, Shrivastava K et al. Role of color doppler in the diagnosis of intrauterine growth

restriction (IUGR). Int J Reprod Contracept Obstet Gynecol 2013; 2(4): 566-572.

Parra‐Saavedra M, Crovetto F, Triunfo S et al. Added value of umbilical vein flow as a predictor of perinatal

outcome in term small‐for‐gestational‐age fetuses. Ultrasound Obstet Gynecol 2013: 42: 189-195.

Cruz‐Martinez R, Savchev S, Cruz‐Lemini M et al. 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: 273-278.

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Published

2019-10-10