STUDY OF FETAL DOPPLER INDICES AND AMNIOTIC FLUID INDEX IN GROWTHLY-RESTRICTED FETUSES

Mohamed Adel El-Sayed*, Zakaria Fouad Sanad, Alaa El-Deen Fathallah El-Halaby, Samar Mohamed Al-Asaaly, Abdel-Naser Abdel-Ati Gad Allah, Ayman El-Dorf and Hossam Talat

ABSTRACT

Aim of the study: To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cere To evaluate the association between renal artery (RA) and middle cereTo evaluate the association between renal artery (RA) and middle cerebral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) bral artery (MCA) resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal resistance indices (RI) and amniotic fluid index as predictors of growthly restricted fetuses their impact on fetal outcome. outcome. outcome. outcome. outcome. outcome. Type of the study:Type of the study:Type of the study: Type of the study:Type of the study:Type of the study:Type of the study:Type of the study: Type of the study:Type of the study:Type of the study: Type of the study:Type of the study: Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Prospective descriptive analytical study. Setting: Department of Obstetrics and Gynecology Menof General Hospital-Egyptian Ministry of Health and Menoufia University Hospital-Menoufia University, Egypt. Methods: Over almost 1.5 years, examination of a total 40 pregnant women between 34- 38 weeks of gestation. Women were divided into 2 groups; women with normal pregnancy (group I, n=20) and women with IUGR pregnancy (group II, n=20) were recruited and underwent ultrasonography (U/S) for amniotic fluid index (AFI) which was measured using four quadrants technique, and Doppler resistance indices of fetal renal artery (FRA) and middle cerebral artery (MCA), All data collected and correlated to see their impact on fetal outcome. Results: The Doppler index and the artery with highest coefficient were the fetal renal artery and its resistance index. The coefficient for this Doppler index was -0.78. In other word the resistance index of fetal renal artery has the maximum predictive as well as diagnostic value for intrauterine growth restriction. Accordingly the FRA RI had Cut off point 0.96, MCA RI had Cut off point 0.72, In the present study, Both FRA RI and MCA RI were equally sensitive (sensitivity 90%), and AFI had comparably low sensitivity (sensitivity 80%) in predicting adverse outcomes (5 minutes Apgar score < 7, death, meconium aspiration, admission to ICU). FRA RI was more specific (specificity 100%) (PPV 100%) than either MCA RI (specificity 95%) (PPV 94.7%) or AFI (specificity 85%) (PPV 84.2%) alone in predicting any adverse out come. While negative predictive value of FRA RI was 90.9% when compared to 90.5% for MCA RI and 80.6% for AFI. Diagnostic accuracy of FRA RI (accuracy 95%) was better than MCA RI (accuracy 92.5%) and AFI (accuracy 82.5%) in predicting adverse outcomes. Conclusion: This study has shown that abnormal AFI, MCA RI and FRA RI in particular are a strong predictor of adverse perinatal outcome in IUGR. MCA RI is more useful than AFI in prediction IUGR outcome when considered individually. FRA RI was more specific than either MCA RI or AFI alone in predicting any adverse outcomes. Combined sonographic and Doppler parameters such as Low EFW and low AFI as well as low MCA RI and High FRA RI have better sensitive and predictive value for estimation the adverse outcome. Further studies and randomized controlled trials are needed.

Keywords: (MCA: Middle cerebral artery, FRA: Fetal renal artery, RI: Resistance index, IUGR: Intrauterine growth restriction, U/S: Ultrasonography Ultrasonography UltrasonographyUltrasonographyUltrasonographyUltrasonographyUltrasonographyUltrasonography Ultrasonogr