VP37.13: Clinical value of TEI index as an adjunct to Doppler velocimetry in diagnosis, surveillance and management of fetal growth restriction: a case report

Abstract

A 31-year-old G2P0 (0100) was noted at 30 weeks gestation to have fetal growth lag on prenatal sonography. Cerebroplacental ratio was abnormal. Placental infarcts were noted. Placental mapping further revealed a Battledore placenta. At this time, TEI index was normal at 0.35. The patient was non-diabetic and non-hypertensive. She had a previous stillbirth at 28 weeks in her previous pregnancy. Anomaly scan was reviewed, infectious disease screening was carried out and results were unremarkable. Work-up for antiphospholipid antibody syndrome was suggested but patient was unable to comply. The patient was given antenatal steroids. Close fetal surveillance was carried out, with daily CTG, BPP twice weekly and weekly Doppler velocimetry. At 32 weeks, umbilical artery Doppler showed intermittent absent end diastolic flow with elevated pusatility index (PI). MCA PI was decreased, with an abnormal cerebroplacental ratio of 0.6. TEI index was 0.53. Family conference was done, with the decision to push as near to term as possible. At 33 weeks of gestation, absent end diastolic flow in the umbilical artery was noted, with deepening A-wave of the ductus venosus, and an elevated TEI index of 0.59. NST revealed persistently minimal variability. Thus intervention was done and patient delivered a livebaby boy weighing 1.7kg. Grossly, the placenta was small weighing 300 grams and the cord was thin, measuring 1cm, inserted at the placental edge. Histopathology report revealed placenta with infarcts and umbilical cord with venous thrombosis. Both mother and baby had unremarkable postpartum course and were discharged well. This case shows how TEI index can be used to augment findings on Doppler velocimetry in the surveillance and management of preterm fetuses with IUGR, secondary to uteroplacental insufficiency. Results from these investigations can guide the clinicians in making decisions regarding the timing of delivery to ensure the best maternal and fetal outcomes.