ALTERED ARTERIAL DOPPLER FLOW PATTERN AND PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION


Kiran Kumar Shetty, Krishnananda Nayak, Pratap Kumar, Ranjan Shetty, Jyothi ., Leslie Edward Lewis, Shreemathi S Maiyya

Abstract


ABSTRACT
Objectives: Intrauterine growth restriction (IUGR) is one of the common conditions that interfere with the growth of the fetus accounting for 10-15%
of pregnant woman. Literature explores a wide range of incidence of perinatal complication including mortality among IUGR pregnancies. Limited
data available on these complications confined to coastal Karnataka and its association with abnormal arterial Doppler flow pattern. To study the
perinatal complications associated with IUGR pregnancies and its prevalence in comparison to healthy controls of comparable gestational age.
Methods: This cohort study screened 53 IUGR fetuses by an antenatal scan at gestational age of 27 weeks or more. The diagnosis of IUGR was made
according to established criteria from SOGC clinical practice guidelines August 2013. The data also included 48 appropriate for gestational age fetuses
with healthy mothers with the comparable gestational week. Experienced cardiac sonographer and gynecologist performed fetal echocardiography
(ECHO) using Vivid 7, GE health-care system ECHO machine with the convex transducer of frequency 1.7-2.4 MHz. The study was conducted at south
Indian tertiary care center.
Results: This study included 53 IUGR cases and 48 non-IUGR controls. The mean age was 27±4.37 and 26.88±3.14 years in IUGR and non-IUGR
groups, respectively. Fetal Doppler study variables showed a significant decrease in peak aortic velocity and velocity time integral which was not
evident on other valves, though mitral antegrade flow during atrial contraction was found to be lower among IUGR group. In two-dimensional chamber
quantification of IUGR group revealed significant increase in pulmonary artery dimension, right ventricular (RV) dimension and RV thickness than the
control group (p<0.05). The anthropometric parameters such as weight and length; abdomen circumference was significantly lower in IUGR group,
whereas head circumference found to be more in IUGR group (p<0.001). The gestational weeks at delivery was significantly different among two
groups with IUGR group depicting the early delivery group. p<0.001(35.58±2.92 and 38.5±0.96 in IUGR and non-IUGR groups, respectively). IUGR
group also had prolonged neonatal intensive care unit stay when compared to controls (p<0.001).
Conclusions: IUGR carries profound course in altered Doppler indices and cardiac function which explore its prediction on mortality and adverse
perinatal outcome. This study showed significant perinatal mortality accounting for 5.6% among IUGR cases when compared to normal. Although
tissue Doppler indices show normal variants, IUGR possesses significant adverse perinatal outcome, however with lesser incidence compared to
severe form of IUGR subsets who show altered tissue annular velocities.
Keywords: Intrauterine growth restriction, Echocardiography, Doppler, Perinatal.


| PDF |

References


REFERENCES

Chauhan SP, Gupta LM, Hendrix NW, Berghella V; American College of Obstetricians and Gynecologists. Intrauterine growth restriction: Comparison of American College of Obstetricians and Gynecologists practice bulletin with other national guidelines. Am J Obstet Gynecol 2009;200(4):409.e1-6.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008;371(9610):417-40.

Jenkins JG, Khan MM. Anaesthesia for Caesarean section: A survey in a UK region from 1992 to 2002. Anaesthesia 2003;58(11):1114-8.

Chauhan SP, Magann EF. Screening for fetal growth restriction. Clin Obstet Gynecol 2006;49(2):284-94.

Lausman A, Kingdom J; Maternal Fetal Medicine Committee, Gagnon R, Basso M, Bos H, et al. Intrauterine growth restriction: Screening, diagnosis, and management. J Obstet Gynaecol Can 2013;35(8):741-57.

Hernandez-Andrade E, Crispi F, Benavides-Serralde JA, Plasencia W, Diesel HF, Eixarch E, et al. Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses. Ultrasound Obstet Gynecol 2009;34(4):430-6.

Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelöer BJ, Kok HJ, et al. Monitoring of fetuses with intrauterine growth restriction: Alongitudinal study. Ultrasound Obstet Gynecol 2001;18(6):564-70.

Figueras F, Benavides A, Del Rio M, Crispi F, Eixarch E, Martinez JM, et al. Monitoring of fetuses with intrauterine growth restriction: Longitudinal changes in ductus venosus and aortic isthmus flow. Ultrasound Obstet Gynecol 2009;33(1):39-43.

Comas M, Crispi F, Cruz-Martinez R, Martinez JM, Figueras F, Gratacós E. Usefulness of myocardial tissue Doppler vs conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction. Am J Obstet Gynecol 2010;203(1):45.e1-7.

Del Río M, Martínez JM, Figueras F, Bennasar M, Olivella A, Palacio M, et al. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. Ultrasound Obstet Gynecol 2008;31(1):41-7.

Hidar S, Zaafouri R, Bouguizane S, Chaïeb A, Jerbi M, Bibi M, et al. Prognostic value of fetal aortic isthmus Doppler waveform in intrauterine growth retardation: Prospective longitudinal study. J Gynecol Obstet Biol Reprod (Paris) 2004;33(8):745-52.




About this article

Title

ALTERED ARTERIAL DOPPLER FLOW PATTERN AND PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

DOI

10.22159/ajpcr.2017.v10i3.16422

Date

01-03-2017

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 3 March 2017 Page: 425-428

Print ISSN

0974-2441

Online ISSN

2455-3891

Statistics

110 Views | 102 Downloads

Authors & Affiliations

Kiran Kumar Shetty
Manipal University, Manipal
India

Krishnananda Nayak

Pratap Kumar

Ranjan Shetty

Jyothi .

Leslie Edward Lewis

Shreemathi S Maiyya


Article Tools


Email this article (Login required)
Email the author (Login required)

Refbacks

  • There are currently no refbacks.