Role of doppler ultrasonography in prediction of adverse perinatal outcome in intrauterine growth retardation (IUGR)

Introduction: A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome - Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation. Materials and methods: A total of 172 singleton pregnancies between 33 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Duration of this study was two years, from December 2019 to November 2021. Results: Out of 172 cases, 146 were live born and 26 were neonatal death. There were 7 cases of intrauterine death of fetuses and 5 were still born. Out of the live born 27 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia. Conclusion: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse fetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised fetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised fetuses and helps to determine the optimal time of delivery.

Study of Umbilical Cord in Normal and Intra Uterine Growth Retardation (IUGR) Placenta.

The purpose of the study is to compare the gross anatomy of umbilical cord in normal placentas and IUGR placentas. MethodsThis is a case control study, conducted in the Department of Anatomy, R.N.T. Medical College, Udaipur among 100 control and 100 IUGR placentas. Placenta was collected as soon as possible after delivery and was examined for gross changes. Then it was fixed in 10% formalin for sections for staining. ResultsIn our study, the marginal attachment of umbilical cord with 0.25 insertion percentage was seen in 35 cases. The association between marginal attachment of the cord and low birth weight is statistically significant. ConclusionsIncreased incidence of marginal cord insertion was associated with low foetal weight. The mean length of umbilical cord varied in the present study between 30 cms and 60 cms in control and IUGR group. No significant difference was seen in the cord length according to type of pregnancy, normal or abnormal. From the literature review, it was anticipated that there would be a wide range of umbilical cord lengths. The umbilical cord may have a central, lateral, marginal or medial insertion. Central and lateral insertions have no clinical importance. Marginal insertions may be more susceptible to vessel rupture and have been associated with foetal growth retardation, stillbirth and neonatal death.

An observational study of early neonatal outcome in babies born to mothers with pregnancy induced hypertension

Background: Hypertensive disorders in pregnancy are a major cause of maternal morbidity and mortality accounting for 15-20% of maternal deaths worldwide. In India the incidence of preeclampsia is reported to be 8-10 percent of the pregnancies objective of this study was to with the above background, this study was carried out to study early neonatal outcome in babies born to PIH mothers, Measure the adverse neonatal outcomes in the early neonatal period and compare the mode of delivery between control group and PIH group.Methods: A total of 58 neonates born to mothers diagnosed having gestational hypertension, preeclampsia, eclampsia were taken as tests (group A), and 100 apparently healthy newborns born to normotensive mothers were enrolled as controls (group B) and followed up to 1st week of life. The outcome measures were compared between groups in terms of mode of delivery, preterm delivery, birth weight, APGAR score, intra uterine growth retardation, early neonatal complications.Results: In group A, 33 had LBW (56.89%) and in group B 18 had LBW (18%). The incidence of preterm deliveries in group A was higher as compared to group B (A- 43.10%, B-17%, p value <0.05). Babies born to PIH mothers had an increased incidence of IUGR, as compared to group B.Conclusions: PIH is one of the major causes of maternal, fetal and early neonatal morbidity and mortality. In this study authors found that risk of LBW, preterm delivery, NICU admission and IUGR in babies born to PIH mothers statistically significant. Early detection of high-risk individual by well trained personnel and timely referral to advanced tertiary center is necessary in bringing down the maternal and neonatal morbidity and mortality.

Impact of Dietary Pattern on Nutritional Status of Pregnant Women in Low and High Strata between the Age Group of 30-39 Years in Mumbai

Background: Maternal Nutrition plays an important role in shaping the mother’s and fetal health. Therefore intake of high salt, high fat, high sugar in the diet might lead to over nutrition among pregnant women due to varied food choices of the since most of the subjects consumed outside food, Sugar Sweetened Beverages such as (Cola, Pepsi, Thumps Up, Soda, Sherbet etc), Processed Food such as(Ready to eat food, Mayonnaise, Cheese spread etc) which consist of increase amount of preservative which might affect the mother and foetal’s health. Since there was increase intake of above food groups and decrease intake of macro and micronutrients in the diet through food group such as Fruits, Nuts and Oilseed, Green Leafy Vegetables etc. Therefore there might be increased risk of Over nutrition among women which might lead to GDM (Gestational Diabetes Mellitus), IUGR(Intra Uterine Growth Retardation), Low Birth weight etc.Aim: To study the impact of dietary pattern on Nutritional of pregnant women in Low and High Strata. Method: A purposive random sampling was done among pregnant women because only 2ndtrimester pregnant women were selected for the study. The 50 subjects were divided into LSES (Lower Socioeconomic Strata) &HSES (Higher Socioeconomic Strata) on the basis of Kuppuswamy Index. The dietary pattern of the subjects was assessed through FFQ (Food Frequency Questionnaire) & 3 Day Diet Recall. Result: There was increase consumptionof High Fat, High Salt, High Sugar in the diet through consumption if food group such as Outside Food, Processed Food, Sugar Sweetened Beverages etc and in comparison the consumption of Macro and Micronutrient rich food group was lower which included Fruits, Green Leafy Vegetables, Nuts and oilseed etc. In Lower Strata the consumption of above food group was low because they were financially not stable therefore they were given additional services where the company paid their ration balance so that they could consume selective food group which were costing comparatively more. Since the RDA(Recommended Dietary Allowances) requirements were not met therefore the women were prescribed Iron, Calcium and Folic Acid supplements in the diet to decrease the risk ofMaternal and fetal complication such as GDM(Gestational Diabetes Mellitus), NTD(Neural Tube Defect), IUGR(Intra Uterine Growth Retardation) etc.Conclusion: Therefore to decrease the risk of Maternal and Fetal Complications intake of Macro and Micro nutritions in the diet is imperative and it is important to organize Nutrition Intervention programmes and counsel the pregnant women about Maternal Nutrition and how decrease intake of Nutrients in the diet might lead to Maternal Under nutrition and over nutrition and its related risk

Retinal Hemorrhage Incidence of Newborn with Intra-uterine Growth Retardation in Korea

PURPOSE: We report 3 cases of patients with retinal hemorrhage among 27 newborns with intrauterine growth retardation. CASE SUMMARY: Twenty-seven newborns with intrauterine growth retardation were examined using the indirect ophthalmoscope for confirming retinal hemorrhage which was observed in 3 patients. The mean gestational age and birth weight (g) of the 3 patients were 37⁺⁶ weeks and 2,086.7 g, respectively. Among the 3 newborns, 1 patient's mother had oligohydramnios. Two patients were delivered vaginally and 1 by cesarean section. All 3 patients had no birth trauma and the retinal hemorrhage was resolved within 2 weeks after the first eye examination. CONCLUSIONS: We observed 3 cases with retinal hemorrhage in neonates with intrauterine growth retardation which improved within 2 weeks.

A dual effect of N-acetylcysteine on lipopolysaccharide-induced fetal damage in mice / 中国药理学通报

Aim To investigate the effect of N-acetylcysteine (NAC) pretreatment/posttreatment on lipopolysaccharide (LPS)-induced intra-uterine fetal death (IUFD) and intra-uterine growth retardation (IUGR) in mice.Methods In the first experiment,all pregnant mice except controls received an intraperitoneal (75 ?g?kg-1) injection of LPS on gd 15~17.In LPS+NAC groups,the pregnant mice were treated with NAC before and/or after LPS. The saline-and NAC-treated pregnant mice served as controls. The dams were sacrificed on gd 18. In the second experiment,all pregnant mice except controls received an intraperitoneal (75 ?g?kg-1) injection of LPS on gd 15. In LPS+NAC groups,the pregnant mice were treated with NAC before and/or after LPS. The saline-and NAC-treated pregnant mice served as controls. The dams were sacrificed at 1.5 h or 6 h after LPS.Results pretreatment with NAC significantly alleviated LPS-induced fetal mortality and reversed LPS-induced growth development retardation.Correspondingly,pretreatment with NAC significantly attenuated LPS-induced elevation in TNF-? concentration in maternal serum and amniotic fluid and lipid peroxidation in maternal and fetal livers. By contrast to pretreatment,posttreatment with NAC had no effect on LPS-induced TNF-? production and lipid peroxidation,and did not protect against LPS-induced IUFD and IUGR and in fact aggravated LPS-induced preterm labor.Conclusion Pretreatment with NAC attenuates LPS-induced IUFD and IUGR,whereas posttreatment with NAC aggravates LPS-induced preterm labor.