A study of Doppler Prediction of Adverse Perinatal Outcome in Growth Restricted Fetuses

Fetal growth restriction is associated with substantial perinatal mortality and morbidity. Incidence of fetal demise, birth asphyxia, meconium aspiration, neonatal hypoglycemia and hypothermia are all increased, as is the prevalence of abnormal neurological development. Postnatal growth and development of growth restricted fetuses depends on the cause of restriction, nutrition in infancy and social environment. Infants with growth restriction due to congenital, viral infection, chromosomal or maternal constitutional factors remain small throughout life. Those infants with in utero growth restriction due to placental insufficiency will often have catch up growth after birth and approach their inherited growth potential when provided with an optimal environment. Aim of the study is to detect any abnormalities in feto placental unit and fetal circulation in IUGR. To identify the hypoxemic fetus & timing delivery so as to precede acidemia. To correlate the occurrence of adverse perinatal outcome with degree of abnormality in Doppler indices. A note was made of the maternal weight, blood pressure and obstetric examination findings of fundal height and various laboratory investigation results. Those with uterine fundal height less than 3cms from the expected height were clinically diagnosed as IUGR and ultra sound examination was done with special emphasis on morphometric measurements. Abdominal circumference less than 5th percentile and estimated fetal weight less than 10th percentile for that gestational age were selected for study. In cases with risk factors, serial sonography was done to identify fetal growth restriction. Initial dating scan followed by second ultra-sound examination was done at around 34 to 36 weeks. Gray scale fetometry is a reliable method to distinguish IUGR & normal fetuses. However it does not detect adverse outcome. Predictive capability of Doppler in confirmed IUGR cases were analyzed. By analyzing abnormal Doppler indices, the fetal hemodynamic& compromise secondary to hypoxemia can be accurately pinpointed. Timely intervention before the onset of academia (altered ducts venous hemodynamic) can effectively reduce perinatal mortality.