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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 12, Issue 3, October 2014 pp 449-453
Role of colour doppler evaluation of middle cerebral and umbilical arteries in intrauterine growth restriction and prediction of adverse perinatal outcome
Vishwanath G Kumbar1, Vijayalakshmi N2, Vinod Xavier Joseph3, Richard Thomas4, Tessa N Kaneria5, Sandeep M B6, Gouri B Kaveriappa7
1PG Resident, 2,3Senior Resident, 4,5,6,7Assistant Professor, Department of Radio diagnosis, Father Muller Medical College, Mangalore, Karnataka, INDIA.
Background and Objectives: Objective of our study was to evaluate the usefulness of middle cerebral artery (MCA) and umbilical artery (UA) Doppler in the diagnosis of intrauterine growth restriction (IUGR) and its prediction of adverse perinatal outcome in clinically suspected IUGR pregnancies and to establish the role of Doppler ultrasound in the management of IUGR pregnancy. Materials and Methods: Data were analysed from 40 cases with clinical suspicion of IUGR between 31 to 40 weeks of gestation from June 2011 to June 2013. Pulsatility index (PI) was used as the Doppler index. The UA and MCA PI was considered abnormal if the value was >95th percentile and <5th percentile of previously published values for gestational age, respectively. Cut-off value of 1.08 was used for MCA/UA PI ratio; velocimetry above 1.08 was considered normal and if below abnormal. The fetus was considered IUGR if the estimated fetal weight (EFW) was <10th percentile of previously published values for gestational age. Pregnancies with documented major congenital abnormality and multiple gestations were excluded from the study. Findings of Doppler studies were correlated with the EFW and the following adverse perinatal outcomes: perinatal death, emergency caesarian section for fetal distress, low Apgar score (5min Apgar <7), and admission to neonatal intensive care unit for complications of IUGR, pregnancy outcome was considered favourable when these were absent. Results: Cerebroplacental ratio (MCA/UA PI) was the most sensitive parameter (95.8%) to predict adverse outcome. It was more sensitive than UA PI (91%) and MCA PI (87.5%). Diagnostic accuracy of cerebroplacental ratio (90%) was better than UA PI (88%) and MCA PI (66%) in predicting adverse outcomes. MCA/UA PI had less diagnostic accuracy (65%) in diagnosing IUGR than predicting its adverse outcome (90%). Conclusion: Cerebroplacental Ratio (MCA/UA PI) is a better predictor of adverse perinatal outcome than an abnormal MCA PI or UA PI, however has less diagnostic accuracy in the diagnosis of IUGR compared to prediction of adverse perinatal outcome.