Predicting IUGR by Uterine and Umbilical doppler: Though Old but Gold

Abstract

Introduction- The uterine and umbilical artery Doppler interrogation is an established non-invasive tool for evaluation of placental blood flow in pregnancy. The doppler studies have huge potential in detecting placental insufficiency which increases the risk of complications like preeclampsia, intrauterine growth-restriction (IUGR).This leads to early prediction and better surveillance, which ultimately results in reduction of maternal and perinatal mortality. Objective- This study was aimed to evaluate and compare the uterine and umbilical artery Doppler indices for early prediction of IUGR. Method- This prospective observational study was conducted over one year on 100 low-risk and 50 high-risk singleton pregnancies. All antenatal women were subjected to screening Doppler studies between 21-25 weeks and 31-35 weeks and followed up for subsequent development of IUGR and other pregnancy outcomes. Results: Out of the 150 study population, 19 mothers delivered IUGR fetus with incidence of 12.67% (5% in low-risk and 28% in high-risk women). 48 study participants had abnormal Doppler values; 43 had uterine artery and 17 had umbilical artery Doppler abnormality. 12 women had both uterine and umbilical artery Doppler abnormalities, out of these 9 developed IUGR. Out of 5 women who had bilateral persistent uterine artery diastolic notches, 3 delivered IUGR baby. For predicting IUGR in second trimester, the right uterine RI was most sensitive with highest NPV and right uterine PI was most specific. The PPV of PI of right uterine and umbilical artery was highest during the time. For IUGR prediction in third trimester, all Doppler parameters were highly specific and had good NPV. The sensitivity of all the parameters was low, the highest being 37% for left uterine RI and S/D. The PPV of umbilical artery RI (83%) was significantly higher than others. In both the trimesters the sensitivity, specificity and NPV of all the Doppler parameters was similar. The combined abnormal uterine and umbilical artery Doppler reveals a higher sensitivity (47.37%), NPV (92.81%) and PPV (75%), thus a better predictor of IUGR. Conclusion: The Doppler velocimetry is a useful tool for placental circulation surveillance especially in high-risk pregnancies. It is recommended to perform second trimester Doppler meticulously for early prediction and timely intervention in high-risk pregnancy. The second trimester uterine artery RI, persistent uterine artery diastolic notch, combined Doppler abnormalities of both arteries has good predictive value for growth restriction.