Evaluation of the Diagnostic Criteria of Ultrasonographic Parameters In The Prediction of Intrauterine Growth Restriction

Dr.Haritha Nimmagadda, Dr.Priti Kapoor, Ms.Ritika Ladwal

Aim: To evaluate the diagnostic criteria of Ultrasonographic parameters to predict intrauterine growth restriction. Methods: Normal pregnant females at different gestational ages that come for normal ultrasonography for routine check were recruited for the study. The USG markers to identify IUGR were assessed. Results: The umbilical artery indices such as S/D ratio decreased from 2.63 to 1.96. In addition, PI (Pulsatility Index) decreased from 1.24 to 0.60 & RI decreased from 0.62 to 0.48 from 32 weeks onwards respectively. Doppler indices of MCA decrease after 32 weeks. The middle cerebral artery indices such as PI decreased from 2.16 to 1.36 and RI decreased from 0.89 to 0.62 from 32 weeks onwards. In control group Cerebro Placental Ratio (CPR) was more than 1. Out of 50 cases of the study group, 25 cases shows PI of Umbilical artery more than 2 SD, 23 cases with SDR of umbilical artery > 3, 20 cases with SDR > 95th percentile whereas in middle cerebral artery 15 cases with SDR > 95th percentile and 27 cases with CPR < 1. The prevalence of IUGR among the study group was 51.5%. The best cut-off value of the TCD/AC ratio for predicting IUGR was 15.4%, giving the sensitivity, specificity, positive predictive value and negative predictive value of 73.26%, 80.25%, 79.75%, and 73.86%, respectively and overall diagnostic accuracy was 92.4%. Conclusions We conclude that, no single non-Doppler sonographic parameter permits the confident diagnosis of IUGR. Multiple Doppler and conventional sonographic parameters shows increase sensitivity and predictivity than single parameter in the study group. Low Estimated Fetal Weight combined with Umbilical (Systolic Diastolic Ratio) SDR >2 SD and HC/AC ratio combined with SDR >2 SD parameters shows increased predictivity and sensitivity. Considering that C/U RI (Cerebral/Uterine Resistivity Index) reflects not only the circulatory insufficiency of the placenta by alteration in the umbilical resistance index, but also the adaptive changes resulting in modification of the middle cerebral resistance index, it seemed to be a potentially useful tool in predicting adverse perinatal outcome in high risk cases. Our results support the correlation between abnormal fetal C/U RI and adverse perinatal outcome in patients with IUGR.