Role of colour doppler indices in diagnosing intrauterine growth restriction in high risk pregnancies in second and third trimester

Abstract

Intrauterine growth restriction (IUGR) is associated with impaired neurological development of child, increased morbidity and increased risk of death during perinatal period. Doppler ultrasound during pregnancy is a useful tool for early detection of IUGR and this helps in early management to prevent further complications associated with IUGR.To study efficacy of color doppler in diagnosing Intrauterine growth restriction in high risk pregnancies in second and third trimester.Diagnostic efficacy study was conducted among 100 subjects with high risk pregnancy presenting in second and third trimester. IUGR was suspected when there was a growth lag of >4 weeks between gestational age and fundal height. Further two-dimensional ultrasound was performed. Bi-parietal diameter, Head circumference, Abdominal circumference, Femur length were noted, estimated fetal weight was calculated. IUGR fetuses were identified if abdominal circumference is<5 percentile and estimated fetal weight was<10 percentile for that gestational age. Vessels studied were Uterine artery, Umbilical artery, Middle cerebral artery, Ductus venosus. The doppler indices studied were RI, PI, S/D, Cerebro-Placental ratio (CPR). Majority were of 22-25 years (52.5%); 53.75% were primigravida; 41.25% presented at 33-37 weeks; 46.25% had gestational hypertension. The overall sensitivity of doppler indices as seen in the present study was good (89.9%) but specificity was only 9.1%. Among the other indices, CPR had the best diagnostic utility with sensitivity=64%; specificity=100% and PPV=100% followed by umbilical artery doppler with sensitivity=55.1%; specificity=81.8% and PPV=96.1%.The overall color doppler indices are highly sensitive in detection of IUGR and lacks the specificity. CPR and Umbilical artery doppler can be used with more reliability.