Doppler prediction of adverse perinatal outcome in PIH and IUGR

Purpose: To determine and compare the diagnostic performance of Dopler sonography of fetal middle cerebral artery (MCA), descending abdominal aorta (DAA), umbilical artery (UA), umbilical vein (UV) and inferior vea cava (IVC) for predictoin of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre-eclampsia (PET). Materials and methods: Fifty-eight Singleton pregnancies beyond 30 weeks of gestation complicated by intrauterine growth restriction and severe pre-eclampsia or both were prospectively examined with Doppler US of the UA, MCA, DAA, UV and IVC. Results: Thirty-six patients of the 58 included in the study population had at least one major or minor adverse outcome. Major adverse outcome criteria included perinatal deaths - includinag intrauterine and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage and necrotizing enterocolitis. Minor outcomes included cesarean delivery for fetal distress, APGAR score below 7 at 5 minutes, admission to neonatal intensive care unit (NICU) for treatment. Conclusion: S/D ratio of MCA/UA is the most sensitive and specific index in predicting major perinatal adverse outcome (83% and 75%), while umbilical artery S/D ratio is the most sensitive index (66.6%) in predicting any adverse perinatal outcome i.e. including both major and minor outcome. MCA pulsatility index (P.I) is the most specific index (90.9%) for predicting in any adverse perinatal outcome. The sensitivity of the Doppler studies can be significantly increased by studying multiple vessels (91.6%). Hence we conclude that Doppler studies of multiple vessels in the fetoplacental circulation can help in the monitoring of compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of delivery in complicated pregnancies.