Title: Maternal Risk Factors and Imaging findings in Intrauterine Growth Restriction
Authors: Dr Khan Tahseen, Dr Shaikh Zohaib Farooque, Dr RM Saraogi
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.28
Abstract
Introduction: Intrauterine growth restriction (IUGR) designates a fetus that has not reached its growth potential because of genetic or environmental factors. The present study was conducted to assess the maternal risk factors leading to IUGR and the role of ultrasonography and Doppler findings in detecting IUGR in pregnant females presenting to our hospital.
Methodology: The present prospective study at a tertiary care hospital included 50 pregnant females with foetal growth restriction. Data such as demographic information, correct gestational age, parity, estimated fetal weight, ultrasound and Doppler findings were noted. Anthropometric measurements on ultrasonography were compared against the standard values suggested by Hadlock et al at different gestational periods.
Results: The most common risk factor for IUGR was pre-eclampsia (42%). Anaemia was present in 20% of the cases and no risk factor could be detected in 14% of the cases. Majority of the case had asymmetric growth restriction (84%) and 70% of the placenta on gross examination revealed calcifications. Approximately two thirds of the cases had amniotic fluid index between 7 to 9 cm and fundal height and abdominal girth was decreased in 82% of the cases each. Most common Doppler finding was bilateral or ipsilateral diastolic notches in uterine artery (34%). Mean BPD, AC and FL were found to be lower among our cases as compared to Hadlock’s standard values among cases of different gestational age.
Conclusions: Ultrasonography and Doppler studies can help in the timely detection of IUGR so that an obstetrician can plan the management accordingly.
Keywords: Doppler; fetal growth; Intrauterine growth restriction; ultrasonography.
References
Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. Bmj. 2013 Jan 24;346:f108.
Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high‐risk pregnancies. Cochrane database of systematic reviews. 2017(6).
Berkley E, Chauhan SP, Abuhamad A, Society for Maternal-Fetal Medicine Publications Committee. Doppler assessment of the fetus with intrauterine growth restriction. American journal of obstetrics and gynecology. 2012 Apr 1;206(4):300-8.
Hadlock FP, Harrist RB, Martinez‐Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181: 129–133.
Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science 2005;308:1592–4.
Hung TH, Skepper JN, Burton GJ. In vitro ischemia – reperfusion injury in term human placenta as a model for oxydative stress in pathological pregnancies. Am J Pathol 2001;159:1031–43.
Klebanoff MA, Shiono PH, Selby JV, Trachtenberg AI, Graubard BI. Anemia and spontaneous preterm birth. Am J Obstet Gynecol. 1991;164: 59–63.
Rasmussen K. Istherea causal relationship between iron deficiency or iron- deficiency anemia and weight at birth, length of gestation and perinatal mortality? J Nutr. 2001;131(2S–2):S590–601; discussion S601–3.
Xiong X, Buekens P, Alexander S, Demianczuk N, Wollast E. Anemia during pregnancy and birth outcome: a meta-analysis. Am J Perinatol. 2000;17:137–46.
Allen LH. Biological mechanisms that might underlie iron’s effects on fetal growth and preterm birth. J Nutr. 2001;131(2S–2):S581–9.
Lawn JE, Cousens S, Bhutta ZA, Darmstadt GL, Martines J, Paul V, Knippenberg R, Fogstadt H, Shetty P, Horton R. Why are 4 million newborn babies dying each year? Lancet. 2004;364:399–401.
Fitzgerald DE, Drumm JE. Non-invasive measurement of the human circulation using ultrasound: a new method. British Medical Journal 1977;2:1450–1.
Burns PN. Principles of Doppler and color flow. Radiology in Medicine 1993;85:3–16.
Nagar T, Sharma D, Choudhary M, Khoiwal S, Nagar RP, Pandita A. The role of uterine and umbilical arterial doppler in high-risk pregnancy: a prospective observational study from India. Clinical Medicine Insights: Reproductive Health. 2015 Jan;9:CMRH-S24048.
Velauthau L, Plana MN, Kalidindi M, et al. First trimester uterine artery Dop- pler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gyanecol. 2014;43(5):500–507.