Colour Doppler Ultrasound Evaluation of Umbilical Artery and Middle Cerebral Artery in Suspected Intrauterine Growth Restriction Foetuses

Abstract

Background and Aims Intrauterine growth restriction is strongly related to the dynamics of uteroplacental and fetoplacental circulation and is associated with an increased risk of perinatal mortality morbidity and impaired neurodevelopment. A prospective study was performed to establish a role of Umbilical Artery UA and Middle Cerebral Artery MCA Doppler ultrasound USG in predicting perinatal outcome in clinically suspected Intrauterine growth restriction IUGR pregnancies and to determine the role of Doppler velocimetry in clinical management of such pregnancies.Methods This prospective observational study was conducted over a period of 17 months November 2019 - March 2021 and included 50 cases. After a regular obstetric ultrasound evaluation special importance was given to measure Doppler parameters such as Pulsatility Indices PI of Umbilical Artery and Middle cerebral Artery. Colour Doppler ultrasound was performed using GE LOGIQ F8 having low frequency curvilinear transducer. Follow up Doppler studies were performed if clinically indicated to determine a favourable or a worsening pattern in the Doppler indices. However only the results of first doppler ultrasound were considered for analysis.Results The mean gestational age at the first Doppler US examination was 32.91 weeks plusmn 3.10 weeks. Forty six percent of the foetuses had at least one abnormal outcome. The mean Foetal Heart Rate FHR was 136.32 plusmn 13.5. The mean Estimated Foetal Weight EFW observed was 1.81 plusmn 0.32. Thirty five 70.0 cases were Oligohydramnios and 15 30.0 cases were with adequate amniotic fluid. Twenty three foetuses had abnormal perinatal outcome. MCA PI was most sensitive sensitivity 95.65 more than both Cerebroplacental Ratio MCAUA PI sensitivity 91.3 and UA PI sensitivity 91.3 in predicting any adverse outcome. Cerebroplacental Ratio specificity 81.48 was more specific compared to UA PI Specificity 66.6 and MCA PI Specificity 63 with highest diagnostic accuracy 86 Positive Predictive Value PPV80.8. However UA PI 94.4 had highest Negative Predictive Value followed by Cerebroplacental Ratio 91.66 and MCA PI 90.0.Conclusions The Foetal Doppler indices in particular ratios that include measurements from umbilical and middle cerebral artery help in the detection of the IUGR foetuses. Cerebroplacental ratio MCAUA is a better predictor of abnormal perinatal outcome than MCA PI and UA PI alone.nbspnbsp