Correlation of Doppler assessment of fetal aortic isthmus with perinatal outcome in intrauterine growth restriction

Abstract

Background: The objective of the present study was to find out association between aortic isthmus Doppler changes and perinatal outcome in growth restricted fetuses with placental insufficiency.Methods: It is a prospective case control study, cases were 43 pregnant women with fetal growth restriction (FGR) with abnormal umbilical artery (UA) Doppler while 43 pregnant women with FGR but normal UA doppler, matched with period of gestation were taken as control. The direction of blood flow in aortic isthmus studied which may be antegrade, absent or retrograde and correlation between qualitative parameters of umbilical artery, aortic isthmus and ductus venosus were studied. Quantitative parameters, PI and RI were also calculated. Patients were managed as per hospital protocols. Perinatal outcome and any adverse event e.g. stillbirth, neonatal death, respiratory distress syndrome, intensive care unit stay >14 days etc. was noted.Results: The number of intrauterine death (IUD) and still birth was increased in women with absent and retrograde flow in aortic isthmus, 66.7% and 71.4% respectively (p value <0.001). Retrograde blood flow in the aortic isthmus is consistently associated with absent or reverse end diastolic velocity in umbilical artery and ductus venosus.Conclusions: Doppler of aortic isthmus is an additional parameter to assess severity of FGR. It plays an important role in termination of preterm FGR fetuses.

Fetal aortic isthmus Doppler assessment to predict the adverse perinatal outcomes associated with fetal growth restriction: systematic review and meta-analysis

“…All the six studies included FGR fetuses with an EFW below the 10th percentile for gestational age (Table 1 ). Three studies included FGR with an abnormal umbilical artery Doppler [ 36 , 39 , 40 ], and one study included fetuses with FRG and a cerebroplacental ratio below the 5th centile [ 38 ]. Concerning the relationship between neonatal outcomes and anterograde and retrograde AoI Doppler flow, all studies assessed perinatal mortality, intrauterine death, and neonatal death rates.…”

“…Women with anterograde AoI Doppler flow had a mean or median gestational age of 32.2–37.6 weeks, whereas those with retrograde AoI Doppler flow had a mean or median gestational age of 27.2–35.33 weeks. Tantuway et al [ 39 ] did not report the gestational age at the moment of delivery. Five of the six studies assessed the fetal AoI Doppler using either the longitudinal aortic arch or the three-vessel and trachea views with a 30° insonation angle.…”