PROSPECTIVE EVALUATION OF FETAL GROWTH RESTRICTION AND PERINATAL OUTCOMES USING DOPPLER ULTRASOUND IN HIGH-RISK PREGNANCIES

Abstract

BACKGROUND: Fetal development depends on the interplay between fetal growth potential and the maternal intrauterine environment. High-risk conditions such as PIH, oligohydramnios, DM, anemia, and Rh incompatibility often lead to IUGR and adverse perinatal outcomes. Doppler ultrasound assessment of uterine, umbilical, and MCA arteries helps detect altered fetoplacental circulation and identify fetal compromise early.

MATERIALS AND METHODS: This hospital-based prospective study was conducted over 18 months in the Departments of Obstetrics & Gynecology and Pediatrics at a tertiary care center in Tamil Nadu after ethical approval. A total of 120 high-risk pregnant women were enrolled, including cases of asymmetrical IUGR, PIH, oligohydramnios, maternal anemia, DM, and Rh isoimmunization. Twin pregnancies, congenital fetal anomalies, gestation <28 weeks, and those who refused consent were excluded. Participants underwent detailed ultrasound and Doppler evaluation of the uterine arteries, umbilical artery, and fetal middle cerebral artery, measuring S/D ratio, RI, and PI. Fetal growth parameters, amniotic fluid, and estimated fetal weight were assessed. Delivery details, mode of labor, and neonatal outcomes including APGAR score, birth weight, IUGR, stillbirth, and nursery admission were recorded. Newborns were monitored for seven days postpartum. Outcomes were compared between normal and abnormal Doppler groups.

RESULTS: Among 120 high-risk antenatal women, abnormal Doppler findings were most frequent in cases with oligohydramnios plus IUGR (78.6%), followed by PIH (20.8%) and IUGR (16.7%), while other conditions showed normal Doppler. Uterine artery abnormalities were seen in 6.7%, MCA brain-sparing in 8.3%, and umbilical artery abnormalities in 11.7% of cases. Vaginal delivery occurred in 59.4% of normal and 31.6% of abnormal Doppler cases, while LSCS was more frequent in abnormal Doppler (68.4%). Preterm delivery (<37 weeks) occurred in 89.5% of abnormal Doppler cases, and low birth weight (<2.5 kg) was significantly higher (89.5%, p < 0.001). Nursery admission was required in 35% of newborns, predominantly from the abnormal Doppler group (84.2%, p < 0.001). Umbilical artery abnormalities showed the strongest association with adverse outcomes, while isolated uterine artery changes were not significant.

CONCLUSION: In 120 high-risk pregnancies, abnormal Doppler—especially of the umbilical artery—was strongly associated with preterm delivery, low birth weight, and increased nursery admissions. MCA abnormalities showed a weaker association, while isolated uterine artery changes were not significant. Antenatal Doppler is a reliable, non-invasive tool for early detection of fetal compromise. Regular monitoring of umbilical and MCA indices, including the cerebro-placental ratio, can guide timely interventions and improve perinatal outcomes.