One Year Cohort Study, Role Of Umbilical Artery Doppler And Modified Biophysical Profile In Predicting Neonatal Outcome In Intrauterine Growth Restriction, A Hospital Based Study

Abstract

OBJECTIVES The present study was undertaken to correlate the role of umbilical artery Doppler and Modified biophysical profile in predicting adverse neonatal outcome in intrauterine growth restriction. METHODS This one-year cohort study was conducted on a total of 113 patients diagnosed as IUGR (AC < tenth percentile) on sonography beyond 28 weeks of gestation, singleton pregnancies with known LMP and/or 1st trimester scan underwent umbilical artery Doppler and Modified biophysical profile as a part of antepartum fetal testing. We excluded multiple gestation, fetal anomaly, eclampsia, abruption and placenta praevia. Abnormal fetal testing was defined as umbilical artery Doppler with absent or reversed end diastolic flow and Modified biophysical profile as non-reactive NST and/or AFI<5cms. The adverse neonatal outcomes noted were resuscitation at birth (intubation), intra-uterine death, admission to NICU at birth, respiratory distress syndrome, neonatal seizures, necrotizing enterocolitis and early neonatal death. RESULTS In this study the mean maternal age was found to be 25.50 ± 5.38 years in women with good neonatal outcome and 24.01 ± 3.75 years in women with adverse neonatal outcome with more than half (52.21%) of the women that presented as primigravida. 19.46% of the women had abnormal Doppler findings and 25.66% MBPP were abnormal findings. The mean gestational age at delivery was 37.36±1.04 in women with good neonatal outcome and 34.30±2.44 in women with adverse neonatal outcome. In this study, vaginal delivery was noted among 38.93% of the women while 61.06% of the women underwent lower segment caesarean section. All 19 women with AEDF (16.81%) and 2 with REDF underwent LSCS. Similarly, of the 29 women with abnormal MBPP, 8 (7.08%) had vaginal delivery and 21 (18.58%) had lower segment caesarean section. The mean weight of the babies was 2.14±0.5 Kgs in women with good outcome and 1.42±0.35 kgs in women with adverse outcome. 38 (33.6%) babies required NICU admission at birth, of which 31 admissions were for preterm low birth weight and 6 were for term low birth weight. There were 7 early neonatal deaths, of which 6 were due to necrotizing enterocolitis and 1 due to respiratory distress syndrome and 3 intra-uterine fetal deaths had occurred. Abnormal Doppler was significantly associated with NICU admissions with OR 11.3 (95%CI 3.7-34.3), NEC with OR 12.2 (95%CI 3.2-46.8), RDS with OR 4.8 (95%CI 1.1-21.4) and END with OR 8.2 (CI 1.5-44.9).The sensitivity of Doppler in predicting adverse neonatal outcome was 47.72% with 98.55% specificity, 95.45% PPV and 74.72% NPV. The sensitivity of MBPP in predicting adverse neonatal outcome was 38.64% with specificity 82.61%, 58.62% PPV and 67.86% NPV. CONCLUSION Modified biophysical profile can be used as an initial surveillance, although it should be coupled with umbilical artery Doppler as it has high specificity and positive predictive value and is a good predictor of adverse neonatal outcomes. Thus, improving the outcome by appropriately timed intervention in the management of IUGR