Research Article

1 Int. J. Pharm. Sci. Rev. Res., 32(1), May June 2015; Article No. 28, Pages: 162-170 ISSN 0976 044X. Research Article Doppler Assessment of the Fetus with Intrauterine Growth Restriction 1 2* 3 1 4 5. Ranjan K. Sahoo , Sibananda Nayak , Sitansu K. Panda , Pravkar B. Pati , Sahadev Sahoo , Mahesh C Sahu 1. Department of Radiology, IMS and Sum Hospital, Siksha O Anusandhan University, K8-Kalinga Nagar, Bhubaneswar, Odisha, India. 2. Dept of Obstetrics and Gynaecology, IMS and Sum Hospital, Siksha O Anusandhan Univ, K8-KalingaNagar, Bhubaneswar, Odisha, India. 3. Department of Anatomy, IMS and Sum Hospital, Siksha O Anusandhan University, K8-Kalinga Nagar, Bhubaneswar, Odisha, India.

2 4. Department of Obstetrics and Gynaecology, Hi-tech Medical College, Bhubaneswar, Odisha, India. 5. Central Research Laboratory, IMS and Sum Hospital, Siksha O Anusandhan University, K8-Kalinga Nagar, Bhubaneswar, Odisha, India. *Corresponding author's E-mail: Accepted on: 17-03-2015; Finalized on: 30-04-2015. ABSTRACT. IUGR babies have got abnormal fetal biometry and doppler variables. However fetal biometry has get inter observer variability. In umbilical artery, S/D ratio, PI and RI of IUGR fetuses were significantly higher than that of normal fetuses ( vs ;. p< , vs ; p< , vs ; p< ). In middle cerebral artery, RI of IUGR fetuses was significantly lower than that of normal fetuses ( vs ; p< ).

3 Cerebroplacental ratio (MCA RI/UA RI) of IUGR fetuses was significantly lower than that of normal fetuses ( vs ; p< MCA index (CPR <1) shows highest sensitivity and productivity in diagnosing IUGR in comparison with other Doppler indices. Thus CPR is a sensitive predictor of fetal growth retardation. However, HC/AC ratio has highest sensitivity and positive predictive value 67% among other non Doppler parameter and has got more diagnostic value. Overall, no single non-Doppler sonographic parameter permits the confident diagnosis of IUGR. Multiple Doppler and conventional sonographic parameters shows increase sensitivity and predictivity than single parameter in the study group.)

4 Combined sonographic and Doppler parameters such as Low EFW and SDR> 2 SD as well as CPR<1 and low EFW have better sensitive and predictive value. Keywords: Cerebro placental ratio, Doppler, Fetal biometry, IUGR. INTRODUCTION and the fetal In obstetrics, Doppler sonography has largely been used to examine the arterial I ntrauterine growth restriction (IUGR) is defined as sonographic estimated fetal weight<10th percentile for gestational According to the American College of Obstetricians and Gynecologists, IUGR is one the most common and complex problems in modern system. There is a vast amount of literature on umbilical artery and fetal arterial blood flow. Elevated impedance to blood flow in the placenta is reflected by abnormal obstetrics.

5 2 This characterization is understandable umbilical artery velocimetric findings (early-stage Doppler considering the various published definitions, poor abnormalities and an elevated pulsatility index).11 In such detection rate, limited preventive or treatment options, situations, growth restriction due to placental multiple associated morbidities and increased likelihood insufficiency occurs, and there may also be a change in of perinatal mortality associated with IUGR. Current the fetal cerebral waveforms that suggests increased challenges in the clinical management of IUGR include blood flow to the brain (brain-sparing effect). accurate diagnosis of the truly growth-restricted fetus, Fetal middle cerebral artery velocimetry has been selection of appropriate fetal surveillance and optimizing suggested as a predictor of fetal hypoxemia when a the timing of Despite the potential for a characteristic increase in diastolic blood velocities was complicated course, antenatal detection of IUGR and its present as a sign of fetal antepartum surveillance can improve outcomes.

6 Although the diagnosis of SGA (small for gestational age) relies on However, abnormal early umbilical artery abnormalities biometric tests but abnormal Doppler tests are diagnostic and middle cerebral artery signals do not necessarily of IUGR. predict the outcome in growth restricted fetuses. In addition, examination of middle cerebral artery During the last 25 years, Doppler velocimetry has become velocimetry in complicated pregnancies has indicated a routine part of fetal surveillance in complicated that the brain-sparing effect is an early sign of fetal pregnancies. Circulatory adaptation of the human fetus in hypoxemia in fetuses who still have adequate reserves to the presence of uteroplacental insufficiency in IUGR 13.

7 Cope with the stress of labor and vaginal delivery and fetuses leads to preferential perfusion of vital organs such 6 7 8,9 therefore is of limited value for the prediction of the fetal as the brain, heart, adrenal glands, and spleen. 14,15. outcome and the optimal time for delivery. Changes in flow velocity waveforms are observed in various fetal vascular beds, and Doppler surveillance is Divon have found that a decrease in the number of based on the relationship between circulatory changes resistance vessels in the tertiary stem villi in the placenta International Journal of Pharmaceutical Sciences Review and Research Available online at 162. Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited.

8 Copyright pro Int. J. Pharm. Sci. Rev. Res., 32(1), May June 2015; Article No. 28, Pages: 162-170 ISSN 0976 044X. causes an increase in resistance, leading to decreased iii) Poor maternal weight gain. flow through the UA and an increase in the UA PI. This is iv) Fundal height of the uterus, on clinical evaluation, described as umbilical placental lagging behind by at least 4 weeks of the expected Fleischer and Schulman have found that in IUGR height according to gestational age. complicated by pregnancy-induced hypertension, there is Ultrasound and Doppler studies were carried out at inadequate trophoblastic invasion of the spiral arteries, department of Radiodignosis, IMS and sum hospital, to leading to increased resistance in the spiral arteries and determine composite ultrasound gestational age, HC/AC.

9 Decreased blood flow in the placental vascular bed and in ratio, estimated fetal weight (EFW) and Doppler velocity the UA, thereby resulting in an increase in the UA PI. This 19 waveforms as well as Doppler velocimetry such as S/D. is described as uteroplacental insufficiency. ratio, PI and RI of umbilical artery and middle cerebral In pregnancies with chronic fetal hypoxia, the blood artery of the foetus. Fetal weight was estimated volume in the fetal circulation is redistributed in favor of according to Haddlock16. vitally important organs, , the heart, kidneys and brain. IUGR was defined as estimated fetal weight of less than Vasodilatation of the MCA, with an increase in diastolic the 10th percentile for gestational age, according to flow through it, results in a decrease in its PI.

10 Sabbagha and Minogue growth curves17. Umbilical artery Thus, in asymmetrical growth retardation, there is a high Doppler indices were estimated on a free loop of cord. UA PI and low MCA PI. As a result, the C/U ratio is lower Waveforms of good quality were collected and analyzed than normal in growth-retarded fetuses. A significant in the absence of fetal breathing movements; on average, association between the C/U ratio and the HC/AC ratio 3 separate readings were performed. can be seen. The C/U ratio remains constant during the During the examination, the women were in a semi- last 10 weeks of gestation and provides better diagnostic recumbent position with the head and chest slightly accuracy than either vessels' PI considered elevated.