Role of Umbilical Artery and Middle Cerebral Artery Doppler in Clinically Suspected Intrauterine Growth Restricted Pregnancies

Background Antepartum foetal surveillance is the corner stone of management aimed at reducing maternal and perinatal mortality and morbidity. Doppler velocimetry of the uteroplacental and foetoplacental circulation can be used to further investigate such complications of pregnancy as foetal growth restriction and other forms of foetal distress that result from foetal hypoxemia or asphyxia. Objectives 1) To evaluate the usefulness of umbilical artery and middle cerebral artery Doppler indices as predictors of adverse perinatal outcome in clinically suspected IUGR Pregnancies.2) To establish the Role of Doppler Ultrasound in the Management of IUGR Pregnancies. Methods This prospective study included 30 pregnant patients with clinically suspected IUGR in the III trimester between 31-40 weeks who got admitted to K. S. Hegde Medical Academy Hospital, from October 2014 to October 2016. Results Total number of 30 IUGR cases were studied. In cases of IUGR, the Cerebroplacental Ratio ( MCA PI/ UAD PI) is less than 1.07 and hence this was taken as the Gold standard for my study. One of the major interpretations obtained while concluding the study is that if the Cerebroplacental Ratio less than 0.95 a) The birth weight less than 2.5kg has a sensitivity of 60 % and specificity of 55 %. b) Fetuses going for Intrauterine Death/ postnatal NICU death have a sensitivity of 56 % and specificity of 80 %. c) Fetuses going for NICU admissions have a sensitivity of 61 % and specificity of 56 %. If the Middle Cerebral Artery RI value is greater than 0.65 in the third trimester, then the fetuses going for IUGR have a sensitivity of 70 % and specificity of 45 %. If the Umbilical Artery S/D Ratio is greater than 2.95 in the third trimester, then the fetuses going for IUGR have a sensitivity and specificity of 70 %. If the Umbilical Artery RI value greater than 0.65 in the third trimester, then the fetuses going for IUGR have a sensitivity of 50 % and specificity of 80 %. Conclusion It is been proved that Doppler technology has a significant impact on our ability to assess the physiological status of the fetus. It can help in identifying the changes in the fetal circulation. This study suggests that, Doppler assessment of foetoplacental circulation including both umbilical and middle cerebral artery is a better prognostic indicator than individual vessels for the prediction of adverse fetal outcomes in Intrauterine Growth Restricted pregnancies. Also the umbilical artery and middle cerebral artery pulsatility indices is equally an important tool in predicting adverse fetal outcome.