DOPPLER

ASSESSMENT OF
INTRAUTERINE
GROWTH
RESTRICTION
 CASE REPORT
¾A 29yr old female patient, primi ,average
GA 30 weeks , k/c/o pre-eclampsia with
altered PIH profile and decreased fetal
movements was referred to our
department for doppler evaluation .
The bilateral uterine arteries , umbilical
artery and the middle cerebral artery were
evaluated.
Right uterine artery waveform demonstrating
low diastolic flow (RI 0.72,S/D 2.8) and an
early diastolic notch
Left Uterine artery waveform demonstrating low
diastolic flow (RI 0.79,S/D 3.3) and an early
diastolic notch.
Reversed diastolic flow seen in the Umbilical
artery (fetal end) with RI of 1.25 and S/D
4.1.This implies a fetus at risk of significant
morbidity/mortality.
Umbilical artery (mid-cord) showing absent end
diastolic flow.
Umbilical artery (placental end) showing absent
end diastolic flow.
Spectral flow within the Middle Cerebral artery
showing increased diastolic flow ( S/D 2.5) and
Brain-sparing effect (RI 0.6 ) .
¾ In severely growth restricted fetus the
ductus-venosus will show reversal of flow
during atrial systole and transmitted
venous pulsation in the umbilical vein.
¾ This was a case of severe growth
restricted fetus in k/c/o pre-eclampsia.

¾ The pregnancy was later terminated and

the baby was shifted to the neonatal
intensive care unit where she is being
treated.
 IUGR
¾ Definition:
Birth weight < 10th percentile for the GA.

¾ Second most common cause of LBW

infants.

¾ Increased risk of perinatal morbidity and

mortality.
 INCIDENCE

OVERALL INCIDENCE:

¾ 2-8% in the western countries.

¾ It is much higher (2-3 times) in the developing

countries.
 RISK FACTORS

¾ Maternal-hypertension, renal
disease,anaemia.
¾ Placental insufficiency.
¾ Multiple pregnancy
¾ Previous growth retarded baby.
 TYPES OF IUGR

Type 1: Time of onset- Second trimester.

Form- symmetrical with the whole of the body

being affected.

Causes- Chromosomal anomalies, intrauterine

infections.
 Type 2
Time of onset-Third trimester.

Form- Asymmetric, with the trunk being

affected than the head.
Commoner form, 70-80% cases
Causes-Hypertension, Uteroplacental
insufficiency.
 DIAGNOSIS
¾ Definitive diagnosis can only be made
after delivery when the weight of the baby
and the gestational age are known.

¾ Prenatal diagnosis is difficult. It requires

the obstetrician to be aware of the
condition and screening patients with high
risk factors.
 DOPPLER
¾ Umbilical artery -Decreased end diastolic flow
and raised doppler indices . In more extreme
cases the end-diastolic flow may be absent or
even reversed.
¾ Uterine artery- Impedance remains high with
early diastolic notch.
¾ Middle cerebral artery- Brain sparing effect.
¾ Ductus-venosus- Reverse flow during atrial
contraction and transmitted venous pulsation in
the umbilical vein.
UMBILICAL ARTERY
UTERINE ARTERY
MIDDLE CEREBRAL ARTERY
DUCTUS VENOSUS
 MANAGEMENT

¾ Itis probably reasonable for the clinicians

to deliver all small for gestational age
fetuses that present with absent /reversed
end diastolic flow after 28 weeks.
 TAKE HOME MESSAGE

¾ Doppler assessment of pregnancy cannot

be used in the diagnosis of IUGR, but it
can be used to co-relate fetal compromise
and assess the fetal well being.
¾ Once identified ,the IUGR fetus should
undergo serial evaluation with both
doppler study and biophysical testing.
THANK YOU