FETAL VENOUS DOPPLER VELOCIMETRY: ROLE IN PREDICTION OF PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

Dr. Aditi Varshney Varma* and Dr. Ankur Varma

ABSTRACT

Background: Uteroplacental insufficiency is a major cause of perinatal mortality and morbidity in growth-restricted fetuses. Doppler ultrasound effectively measures the changes that sequentially appear in fetal arterial and venous systems and can predict adverse perinatal outcome. Venous changes in Doppler, when monitored, are preterminal events that can help frame delivery decisions in preterm infants. Objective: To determine Venous Doppler parameters in Intra uterine growth restricted fetuses (IUGR) and correlate with adverse perinatal outcome. Methods: 77 singleton pregnancies beyond 28 weeks of gestation, without fetal anomalies, that had estimated fetal weight below the 10th percentile for gestational age, were examined by Doppler ultrasound to record fetal cerebro-umbilical, Ductus venosus (DV) and umbilical vein (UV) indices. Fetal perinatal outcomes were noted. Results: The sensitivity, specificity, positive & negative predictive value of DV PI to predict IUGR in the present study was 58.3%, 100%, 100% & 40.5%. The sensitivity, specificity, positive & negative predictive value of DV PI to predict adverse perinatal outcome was 59.5%, 71.4%, 71.4% & 59.52% respectively. The incidence of IUD & neonatal mortality was higher in cases with abnormal DV PI (26%, 20%) than in cases with normal DV PI (4%, 4%) (p 0.026, 0.016), increasing with appearance of absence or reversal of a-wave in DV. 100% cases with pulsations in UV had intrauterine or perinatal demise. Conclusion: Abnormal DV PI and decreased UV velocity is a predictor of adverse perinatal outcome in the setting of abnormal fetal arterial Doppler. These parameters can be monitored in preterm infants to help frame delivery decisions.

Keywords: Ductus venosus, Umbilical vein, Doppler, Intrauterine growth restriction, perinatal mortality, adverse perinatal outcome.