Prajakta Shirish Tumbal1
OBJECTIVE
The objective of this study was to study the foetal and maternal outcomes in pregnancies with IUGR and deranged Doppler. And to study the effect of deranged blood flow velocimetry in management of growth restricted pregnancies.
METHODS
This was a prospective study of 96 antenatal women booked at KEM. Hospital Pune during year 2011-2012 between 28-40 wks. of gestation and ultrasonography estimated foetal weight or abdominal circumference < 10th percentile with Doppler velocimetry derangement constituted the study population. Women included in the study were prospectively followed with weekly or biweekly sonography and Doppler velocimetry of maternal Uterine arteries, Foetal Umbilical artery, Middle Cerebral artery. Depending on degree of Doppler derangement daily Non stress test was performed and results were interpreted. Accordingly decision of timing and mode of delivery was taken. Maternal and foetal outcome were studied with respect to mode of delivery in terms of no. of spontaneous or induced vaginal deliveries, no. of Elective caesarean sections, No. of Emergency caesarean sections and neonatal outcome in terms of gestational age at time delivery, no. of live births or stillbirths, APGAR Score at 5 min, birth weight, NICU admission, No. of days of NICU stay, perinatal morbidity and mortality.
RESULTS
23(24%) women underwent Induction of labour, 22(22%) underwent Elective LSCS and maximum 51(53%) women delivered by Emergency LSCS mainly because of non–reassuring foetal heart rate pattern. Live births were 87(90.6%) and 9(9.4%) foetuses were stillborn. Maximum no. 50 out of 87 live born foetuses were <34 weeks of gestation. These neonates had lower birth weight maximum were between 1000-1500gms, all stillbirths had birth weight <1000gms. Out of 87 live births 21(24.1%) had APGAR score <7. Babies with deranged Doppler had more requirement of NICU care 78(89.6%) and for longer duration 31(40%) required >10 days. Total 32 babies had various complications. In the present study, out of 96 study population 9 were stillborn, 11 were Neonatal death, 78 foetuses required NICU care while 32 had complications. Therefore, perinatal mortality is 20(20.8%) and morbidity is 76(79.2 %).
CONCLUSION
The Doppler pattern follow a longitudinal trend with early changes in the Umbilical artery followed by Middle Cerebral artery and other peripheral arteries. Venous changes follow the arterial pattern and occur in severely compromised foetus and predicts poor perinatal outcome. Compared to other methods of foetal monitoring Doppler has proved to be more sensitive in detecting foetal compromise as early and aids in the appropriate timing of delivery. Doppler indices from the foetal circulation can reliability predict adverse perinatal outcome in high risk pregnancy such as intrauterine growth restriction.
