Role of Foetal Biometry and Doppler Studies in the Evaluation of Intrauterine Growth Restriction

The term intrauterine growth restriction (IUGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size. IUGR is associated with four to eight fold increased risk of perinatal mortality and morbidity.50 % of the survived IUGR children have significant morbidity. Accurate and timely detection of IUGR can prevent adverse outcome of pregnancy to some extent. With the advent of ultrasonography (USG), it has become the most widely used, standard and simple way of detecting and confirming IUGR. Evaluation of IUGR fetuses by Doppler studies are done by studying uterine artery Doppler velocimetry waveforms, foetal arterial Doppler study and foetal envois Doppler studies. Background and objectives Methods This is a descriptive study is for a period of 14 months from May 2014 to July 2015. The population consisted of 100 pregnant women referred from the inpatient ward as well as outpatient department of Obstetrics and Gynecology Department of Maharishi Markandeshwar Hospital and Research Centre, 50 cases with clinically suspected intrauterine growth restriction (IUGR) and another 50 cases with clinically normal pregnancy are included. Results Ultrasound biometry is the gold standard for assessment of foetal size. Foetal weight less than 10th percentile for gestational age is mostly used to diagnosis IUGR but other criteria like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. Interpretation & Conclusion The utero-placental insufficiency seen with IUGR is associated with a rise in vascular resistance in uterine & umbilical arteries which can be estimated by raised pulsatility index, resistance index, systolic/diastolic ratio in these arteries, and persistence of uterine artery diastolic notch, absent & reverse diastolic flow in umbilical artery. In the presence of foetal hypoxemia, central redistribution of blood flow occurs, known as the Brain Sparing Reflex manifested by a fall in Pulsatility index, resistance indices, and systolic/diastolic ratio.