Intrauterine growth restriction; relationship between abnormal umbilical artery doppler and adverse apgar score

ABSTRACT

To compare fetal outcome in normal umbilical artery Doppler findings to abnormal umbilical artery Doppler findings in pregnant women with fetal growth restriction Main outcome measures Umbilical artery Doppler studies apgar score at 1 minute and apgar score at 5 minutes after delivery. Cross sectional, comparative study. Department of Obstetrics and Gynaecology, Military Hospital and Combined Military Hospital, Rawalpindi From Jan 2005 to Jan2007. Patients with fetal growth restriction between 28 to 37 weeks of pregnancy were selected, in whom diagnosis was confirmed by ultrasonography. All patients were followed up with umbilical artery Doppler studies. The study group consisted of 48 women [group I], where the umbilical artery waveform was compromised. The outcome in these was compared with an equal number of controls, where growth restricted fetuses had normal Doppler waveforms [group II]. The mean age of patients in group I was 26.9 years and in group II was 28.6 years Fetuses with abnormal umbilical artery Doppler findings had higher incidence of maternal gestational hypertension and oligohydramnios. Rate of emergency cesarean section for fetal distress was also higher in this group. Growth restricted babies with abnormal umbilical artery Doppler waveforms had lower apgar scores. In babies with normal Doppler studies 91.6% had apgar score above 7 at 5 minutes after birth. In babies with raised RI 78.1%, in babies with abscent end diastolic flow 54.5% and in babies with Reversed end diastolic only 20% had apgar score above 7 at five minutes after birth. The difference was statistically significant [P=0.001]. Umbilical artery velocimetry can distinguish the group of growth restricted fetuses at risk of poor apgar. Growth restricted fetuses with normal Doppler studies are at a lower risk than those with abnormal Doppler findings in terms of poor apgar score