COMPARISON OF PERINATAL OUTCOME OF GROWTH RESTRICTED FOETUSES WITH NORMAL AND ABNORMAL UMBILICAL ARTERY DOPPLER WAVEFORMS
AbstractBackground: Intrauterine growth restriction (IUGR) is a complex problem. It is notorious but a difficult diagnosis. The perinatal mortality can be reduced when the results of umbilical artery Doppler are made available to clinicians to help them intervene more timely and appropriately. This study aimed to compare perinatal outcome of growth restricted foetuses with normal and abnormal umbilical artery doppler waveforms. Methods: This cross-sectional descriptive study was conducted in the radiology department of Mother and Child Health (MCH), Pakistan Institute of Medical Sciences (PIMS), Islamabad from March 2007 to March 2008. A total of 100 pregnant women with growth restricted foetuses were studied with umbilical artery Doppler ultrasound. Fifty women had normal umbilical artery Doppler waveform and the umbilical artery Doppler wave-form was compromised (either absent or reversed) in the 50 pregnancies. These patients were followed up and the perinatal outcomes were recorded and compared. Results: Premature delivery was recorded in 14% in the normal group and 96% in the abnormal group. The number of babies with low birth weight was more in the abnormal group. The neonatal intensive care (NICU) admissions were significantly increased in the abnormal group (82%). The incidence of intra-ventricular haemorrhage was more (18%) in the abnormal umbilical artery Doppler group as compared to normal group (06%). Perinatal deaths were three times more in the abnormal umbilical artery Doppler group as compared to normal. The difference in the perinatal outcome of both group is statistically significant (p=.0001). Conclusion: There is a strong relationship between pregnancy outcome in IUGR babies and abnormal uterine artery doppler waveform (Absent or reversed).Keywords: Intrauterine growth restriction, Umbilical artery Doppler waveform, perinatal outcome
Middleton WD, Kurtz AB, Hertzberg BS. Fetal growth and well-being. In: Middleton WD, Kurtz AB, Hertzberg BS (eds.) Ultrasound: The Requisites, 2nd ed. St Louis: Mosby; 2004.p. 330–41.
Gudmundsson S, Tulzer G , Huhta JC, Marsal K. Venous Doppler in the foetus with absent end diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol 1996;7:262–7.
Disorders of placentation. In: Baker PN, Kenny L, editors. Obstetrics by ten teachers. 18th ed. London: Hodder Arnold; 2006.p. 156–70.
Zafar H, Naz M, Fatima U, Irshad I. Frequency of IUGR in pregnancy induced hypertension. J Univ Med Dent Coll 2012;3(2):8–13.
The Investigation and Management of the Small-for-Gestational-Age Foetus (31)-2002 RCOG Guidelines. 2002. Availabel at: http://www.gestation.net/RCOG%20Small_Gest_Age_Foetus_No31.pdf
Lakhkar BN, Rajagopal RV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging 2006;16:109–16.
Rochelson B, Schulman H, Fleischer A, Farmakides G, Bracero L, Ducey J, et al. The clinical significance of doppler umbilical artery velocimetry in the small for gestational foetus. Am J Obstet Gynecol 1987;156:1223–6.
Burke G, Stuart G, Crowley P, Scanaill SN, Drumm J. Is intrauterine growth retardation with normal umbilical artery flow is a benign condition?. BMJ 1990;300:1044–5.
Craigo SD, Beach ML, Harvey-Wilkes KB, D'Alton ME. Ultrasound predictors of neonatal outcome in intrauterine growth retardation. Am J perinatal 1996;13:465–71.
Berkowitz GS, Chitkara UJ, Rosenberg J, Cogswell C, Walker B, Lahman EA, et al. Sonographic estimation of fetal weight and doppler analysis of umbilical artery velocimetry in the prediction of intrauterine growth retardation: A sprospective study. Am J Obstet Gynecol 1988;158:1149–53.
Rohelson B, Bareere LA, Port J, Farmakides G. Diagnosis of intrauterine growth retardation as two-step process with morphometric ultrasound and doppler artery velocity. J Reprod Med 1992; 37:925–9.
Devendra A, Desai SK, Sheth PN, Prema K. Significance of umbilical artery velocimetry in perinatal outcome of growth restricted foetuses. J Obstet Gynecol India 2005;55:138–43.
Gudmundsson S, Marsal K. Umbilical artery and uteroplacental blood flow velocity waveforms in normal pregnancy- a cross- sectional study. Acta Obstet Gynecol Scand 1988;67:347–54.
Tyrrell SN, Lilford RJ, Macdonald HN, Nelson EJ, Porter J, Gupta JK. Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high-risk pregnancies. Br J Obstet Gynaecol 1990;97:909–16.
Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, Ulmsten U, et al. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age foetuses. Lancet 1992;340:936–40.
Chauhan SP, Reynolds D, Cole J, Scardo JA, Magann EF, Wax J, et al. Absent or reversed end-diastolic flow in the umbilical artery: outcome at a community hospital. J Miss State Med Assoc 2005;46:163–8.
Sezik M, Tuncay G, Yapar EG. Prediction of adverse neonatal outcomes in preeclampsia by absent or reversed end-diastolic flow velocity in the umbilical artery. Gynecol Obstet Invest 2004;57:109–13.
Kurkinen-Raty M, Kivela A, Jouppila P. The clinical significance of an absent end-diastolic velocity in the umbilical artery detected before the 34th week of pregnancy. Acta Obstet Gynecol Scand 1997;76:398–404.
Tannirandorn Y, Phaosavasdi S. Significance of an absent or reversed end-diastolic flow velocity in Doppler umbilical artery waveforms. J Med Assoc Thai 1994;77:81– 6.
Battaglia C, Artini PG, Galli PA, D'Ambrogio G, Droghini F, Genazzani AR. Absent or reversed end-diastolic flow in umbilical artery and severe intrauterine growth retardation. An ominous association. Acta Obstet Gynecol Scand 1993;72:167–71.
23.Cosmi E, Ambrosini G, D'Antona D, Saccardi C, Mari G. Doppler, cardiotocography and biophysical profile changes in growth-restricted foetuses. Obstet Gynecol 2005;106:1240–5.
Schwarze A, Gembruch U, Krapp M, Katalinic A, Germer U, Axt-Fliedner R. Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted foetuses with ARED flow in the umbilical artery-correlation with short-term outcome. Ultrasound Obstet Gynecol 2005;25:573–9.
Gerber S, Hohlfeld P, Viquerat F, Tolsa JF, Vial Y. Intrauterine growth restriction and absent or reverse end-diastolic blood flow in umbilical artery (Doppler class II or III): A retrospective study of short- and long-term fetal morbidity and mortality. Eur J Obstet Gynecol Reprod Biol 2006;126:20–6.
Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 1995;172:1379–87.
Pattison RC, Odendaal HJ, Kirsten G. The relationship between absent end-diastolicb velocities of the umbilical artery and perinatal mortality and morbidity. Early Hum Dev 1993;33:61–9.