ABSTRACT
Background: Foetal growth restriction refers to a condition in which the foetus is unable to achieve its genetically determined growth potential. Doppler velocimetry in FGR not only decides the optimum time of delivery but also the optimum mode of delivery and so authors evaluated the Doppler patterns in growth restricted fetuses.Methods: Nested case-control study conducted among normal and abnormal Doppler groups at a tertiary care teaching hospital in the year 2017.Results: Among 82 growth restricted foetuses, 54 of them had normal Doppler patterns (65.85%) and 28 had abnormal Doppler patterns (34.15%).13(46.5%) had umbilical S/D elevation,2 (7.14%) had AEDV,1(3.57%) with REDV and 12 (42.8%) with CPR<1. Mean maternal age was slightly higher in the abnormal Doppler group. FGR babies with abnormal velocity waveforms had shorter diagnosis to delivery interval than those with normal Doppler and decision for delivery was taken at a lower gestational age. (p value-0.001). Mothers of FGR babies with abnormal Doppler studies underwent emergency caesarean section for non-reassuring foetal heart patterns. (p value-0.001) The mean birth weight was higher (2201.80gm) in Doppler normal FGR and it was 1929.46grams in abnormal umbilical Doppler group and 1363.33gm in AREDV (pvalue-0.001). Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Growth restricted foetuses with normal umbilical velocimetry are at a lower risk than those with abnormal velocimetry in terms of prolonged diagnosis-delivery interval and shorter NICU days. The need for neonatal resuscitation at birth was more in babies with abnormal Doppler velocimetry and absent diastole /reversed diastolic flow of umbilical artery velocimetry.
ABSTRACT
Background: Fetal Growth Restriction (FGR) is the single largest contributing factor to perinatal morbidity in non-anomalous foetuses. Synonymous with Intrauterine Growth Restriction (IUGR), it is defined as an estimated fetal weight less than the10th percentile. Obstetric Doppler has helped in early detection and timely intervention in babies with FGR with significant improvements in perinatal outcomes. Hence, authors evaluated the maternal risk factors and diagnosis-delivery intervals and perinatal outcomes in FGR using Doppler.Methods: This research conducted in a tertiary care hospital in South Kerala included 82 pregnant women who gave birth to neonates with birth weight less than the 10th percentile over a period of1 year (Jan 1, 2017-Dec 31, 2017). Socio-demographic, maternal risk, Diagnosis- delivery interval in FGR and neonatal morbidities were studied.Results: Mean GA at diagnosis in weeks was 34.29 and 35.19 respectively for abnormal and normal Doppler respectively (p value-0.032). The mean birthweight in Doppler abnormal FGR was 272.34 g lesser than in Doppler normal group (p value-0.001). Growth restricted low birth weight neonates had Doppler pattern abnormalities (p value-0.0009). FGR <3rd percentile and AFI <5 had abnormal Doppler (OR:6.7). Abnormal biophysical profile (OR:14) and Non-Reactive NST (OR:3.5) correlated with abnormal Doppler. Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Abnormal Doppler velocimetry is significantly associated with earlier FGR detection, shorter decision- delivery interval, reduction in the mean birthweight and longer NICU stay. Hence, Umbilical artery Doppler and Cerebroplacental index is an integral part of in-utero fetal surveillance to identify impending fetal hypoxia, appropriate management, optimising the timing of delivery and improve perinatal health in FGR.