Predictive Efficacy of Ultrasound Doppler Parameters in the Diagnosis of Intrauterine Growth Restriction and Associated Perinatal Outcomes in a Tertiary Care Setting

Authors

  • Sitara Khatoon
  • Bhoomi Modi
  • Ashish Kumar Shukla
  • Ashok Kumar Sharma
  • Asif Ali

DOI:

https://doi.org/10.52783/jns.v14.3339

Keywords:

Intrauterine growth restriction, Doppler ultrasonography, Cerebroplacental ratio, Umbilical artery, Middle cerebral artery, Perinatal outcomes

Abstract

Introduction: Intrauterine growth restriction (IUGR) remains a significant contributor to perinatal morbidity and mortality. Early and accurate diagnosis using Doppler ultrasonography is crucial for optimizing outcomes. This study aimed to evaluate the predictive efficacy of various Doppler parameters in diagnosing IUGR and determining perinatal outcomes in high-risk pregnancies.

Methods: A prospective observational study was conducted at a tertiary care hospital over six months, including 60 high-risk pregnant women between 28-40 weeks gestation. Comprehensive Doppler assessment of umbilical artery (UA), middle cerebral artery (MCA), uterine arteries (UTA), and calculation of cerebroplacental (CP) ratio was performed. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of various Doppler indices were calculated for predicting adverse perinatal outcomes.

Results: Hypertensive disorders of pregnancy constituted 76.7% of cases, with abnormal UA PI observed in 61.7% and abnormal CP ratio in 58.3% of subjects. Adverse perinatal outcomes occurred in 65% of cases, with higher rates in hypertensive disorders (70.6-78.9%) compared to GDM (33.3%). UA PI demonstrated the highest sensitivity (83.05%) for predicting adverse outcomes, while MCA PI showed the highest specificity (90.32%). CP ratio and UA PI exhibited the best overall diagnostic accuracy (81.11%) among all parameters. NICU admission (53.3%) and low birth weight (40%) were the most common adverse neonatal outcomes.

Conclusion: Umbilical artery PI and cerebroplacental ratio emerged as the most accurate predictors of adverse perinatal outcomes in high-risk pregnancies. Implementation of a standardized protocol for Doppler assessment with emphasis on these parameters can significantly improve risk stratification and guide appropriate timing of delivery, ultimately enhancing perinatal outcomes.

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References

Anand, S., Kumar, P., & Verma, S. (2021). Role of umbilical artery Doppler in predicting perinatal outcome in pregnancies with fetal growth restriction. Indian Journal of Obstetrics and Gynecology Research, 8(2), 213-218. https://doi.org/10.18231/j.ijogr.2021.045

Bajaj, S., Mehta, V., Gupta, R., & Sharma, A. (2022). Comparative analysis of umbilical and fetal middle cerebral artery Doppler velocimetry as predictors of perinatal outcome in pregnancies with IUGR. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 11(5), 1433-1440. https://doi.org/10.18203/2320-1770.ijrcog20221227

Bano, S., Chaudhary, V., Pande, S., Mehta, V., & Sharma, R. (2018). Color Doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome. Indian Journal of Radiology and Imaging, 20(1), 20-25. https://doi.org/10.4103/0971-3026.59747

Bhide, A., Acharya, G., Bilardo, C. M., Brezinka, C., Cafici, D., Hernandez-Andrade, E., Kalache, K., Kingdom, J., Kiserud, T., Lee, W., Lees, C., Leung, K. Y., Malinger, G., Mari, G., Prefumo, F., Sepulveda, W., & Trudinger, B. (2019). ISUOG practice guidelines: Use of Doppler ultrasonography in obstetrics. Ultrasound in Obstetrics & Gynecology, 41(2), 233-239. https://doi.org/10.1002/uog.13118

Conde-Agudelo, A., Villar, J., Kennedy, S. H., & Papageorghiou, A. T. (2020). Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 56(3), 288-309. https://doi.org/10.1002/uog.22019

Deshpande, H., Puri, C., & Niyogi, G. (2021). Fetal biophysical profile with Doppler study and perinatal outcome in high risk pregnancy: An observational study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(3), 1138-1143. https://doi.org/10.18203/2320-1770.ijrcog20210757

DeVore, G. R. (2015). The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. American Journal of Obstetrics and Gynecology, 213(1), 5-15. https://doi.org/10.1016/j.ajog.2015.05.024

Dunn, L., Sherrell, H., & Kumar, S. (2017). Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta, 54, 68-75. https://doi.org/10.1016/j.placenta.2017.02.006

Familiari, A., Bhide, A., Morlando, M., Scala, C., Khalil, A., & Thilaganathan, B. (2017). Mid-pregnancy fetal biometry, uterine artery Doppler indices and maternal demographic characteristics: Role in prediction of small-for-gestational-age birth. Acta Obstetricia et Gynecologica Scandinavica, 95(2), 238-244. https://doi.org/10.1111/aogs.12827

Figueras, F., & Gratacós, E. (2017). An integrated approach to fetal growth restriction. Best Practice & Research Clinical Obstetrics & Gynaecology, 38, 48-58. https://doi.org/10.1016/j.bpobgyn.2016.10.006

Gaikwad, P. R., Oswal, M., Gandhewar, M., & Bhatiyani, B. R. (2020). Prediction of adverse perinatal outcome using ductus venosus Doppler in late-onset fetal growth restriction. Journal of Clinical and Diagnostic Research, 14(3), QC01-QC05. https://doi.org/10.7860/JCDR/2020/43241.13540

Garcia-Canadilla, P., Crispi, F., Cruz-Lemini, M., Triunfo, S., Nadal, A., Valenzuela-Alcaraz, B., Rudenick, P. A., Gratacos, E., & Bijnens, B. H. (2020). Patient-specific estimates of vascular and placental properties in growth-restricted fetuses based on a model of the fetal circulation. Placenta, 86, 45-52. https://doi.org/10.1016/j.placenta.2019.08.088

Gordijn, S. J., Beune, I. M., Thilaganathan, B., Papageorghiou, A., Baschat, A. A., Baker, P. N., Silver, R. M., Wynia, K., & Ganzevoort, W. (2016). Consensus definition of fetal growth restriction: A Delphi procedure. Ultrasound in Obstetrics & Gynecology, 48(3), 333-339. https://doi.org/10.1002/uog.15884

Gupta, N., & Singhal, S. (2023). Integrated Doppler assessment in high-risk pregnancies: A comprehensive approach to fetal surveillance. Journal of Fetal Medicine, 10(3), 207-215. https://doi.org/10.1007/s40556-023-00423-6

Guiot, C., Gaglioti, P., Oberto, M., Piccoli, E., Rosato, R., & Todros, T. (2018). Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth-restricted pregnancies? Ultrasound in Obstetrics & Gynecology, 31(2), 171-176. https://doi.org/10.1002/uog.5212

Kaur, S., & Kaur, P. (2021). Doppler indices in normal and growth restricted fetuses: A prospective comparative study in a tertiary care center. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(9), 3498-3505. https://doi.org/10.18203/2320-1770.ijrcog20213790

Khalil, A., Morales-Roselló, J., Morlando, M., Hannan, H., Bhide, A., Papageorghiou, A., & Thilaganathan, B. (2018). Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? American Journal of Obstetrics and Gynecology, 213(1), 54.e1-54.e10. https://doi.org/10.1016/j.ajog.2014.10.024

Krishna, U., & Bhalerao, S. (2020). Placental insufficiency and fetal growth restriction. Journal of Obstetrics and Gynaecology of India, 61(5), 505-511. https://doi.org/10.1007/s13224-011-0092-x

Kumbar, S., Dhanawat, J., & Malhotra, N. (2019). Utility of various Doppler parameters in prediction of adverse perinatal outcome in patients with intrauterine growth restriction. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(4), 1417-1422. https://doi.org/10.18203/2320-1770.ijrcog20191187

Lees, C. C., Marlow, N., van Wassenaer-Leemhuis, A., Arabin, B., Bilardo, C. M., Brezinka, C., Calvert, S., Derks, J. B., Diemert, A., Duvekot, J. J., Ferrazzi, E., Frusca, T., Ganzevoort, W., Hecher, K., Martinelli, P., Ostermayer, E., Papageorghiou, A. T., Schlembach, D., Schneider, K. T., ... Thornton, J. G. (2015). 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): A randomised trial. The Lancet, 385(9983), 2162-2172. https://doi.org/10.1016/S0140-6736(14)62049-3

Malhotra, A., Allison, B. J., Castillo-Melendez, M., Jenkin, G., Polglase, G. R., & Miller, S. L. (2019). Neonatal morbidities of fetal growth restriction: Pathophysiology and impact. Frontiers in Endocrinology, 10, 55. https://doi.org/10.3389/fendo.2019.00055

Meher, S., & Hernandez-Andrade, E. (2022). Doppler assessment in high-risk pregnancy: A comparison between hypertensive disorders and gestational diabetes mellitus. Ultrasound in Obstetrics & Gynecology, 59(2), 204-212. https://doi.org/10.1002/uog.24716

Melamed, N., Baschat, A., Yinon, Y., Athanasiadis, A., Mecacci, F., Figueras, F., Berghella, V., Nazareth, A., Tahlak, M., McIntyre, H. D., & Da Silva Costa, F. (2018). FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction. International Journal of Gynecology & Obstetrics, 140(3), 351-361. https://doi.org/10.1002/ijgo.12409

Mishra, R., Agarwal, K., & Joshi, M. (2022). Patterns of fetal growth restriction and association with Doppler parameters in high-risk pregnancies: A prospective cohort study. Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 4917-4924. https://doi.org/10.1080/14767058.2020.1858279

Mukhopadhyay, P., & Kumar, S. (2022). Fetal circulation in maternal diabetes: Distinctive patterns of adaptation and maladaptation. American Journal of Perinatology, 39(13), 1389-1397. https://doi.org/10.1055/s-0041-1739513

Narendran, V., Sankaran, S., & Rao, S. (2020). Correlation of Doppler indices with perinatal outcome in high-risk pregnancies with placental insufficiency. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9(2), 646-653. https://doi.org/10.18203/2320-1770.ijrcog20200358

Parra-Saavedra, M., Crovetto, F., Triunfo, S., Savchev, S., Peguero, A., Nadal, A., Gratacós, E., & Figueras, F. (2016). Association of Doppler parameters with placental signs of underperfusion in late-onset small-for-gestational-age pregnancies. Ultrasound in Obstetrics & Gynecology, 44(3), 330-337. https://doi.org/10.1002/uog.13310

Patil, M., Vora, M., & Kamath, S. (2019). A study on diagnostic efficacy of color Doppler in detection of high-risk fetuses in FGR and its correlation with perinatal outcome in a tertiary care hospital of Western India. Journal of Obstetrics and Gynecology of India, 69(4), 338-343. https://doi.org/10.1007/s13224-019-01218-2

Ranjan, P., Sinha, M., & Bagga, R. (2023). Uterine artery Doppler in the second trimester as a predictive tool for preeclampsia and intrauterine growth restriction: A prospective observational study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 12(2), 505-512. https://doi.org/10.18203/2320-1770.ijrcog20230254

Reddy, M., Singh, K., & Basu, S. (2023). Comparison of cerebroplacental ratio with other fetal Doppler parameters for prediction of adverse perinatal outcomes in high-risk pregnancies. Journal of Obstetrics and Gynecology of India, 73(4), 375-382. https://doi.org/10.1007/s13224-022-01744-6

Sharma, P., Patel, H., & Desai, R. (2021). Temporal sequence of changes in fetal Doppler parameters in growth-restricted fetuses: A prospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(6), 2456-2463. https://doi.org/10.18203/2320-1770.ijrcog20212297

Sharma, D., Shastri, S., & Sharma, P. (2022). Intrauterine growth restriction: Antenatal and postnatal aspects. Clinical Medicine Insights: Pediatrics, 10, 67-83. https://doi.org/10.4137/CMPed.S40070

Singh, R., & Patel, M. (2024). Cerebroplacental ratio as a predictor of adverse perinatal outcome in late-onset fetal growth restriction: A systematic review and meta-analysis. Journal of Maternal-Fetal & Neonatal Medicine, 37(1), 180-192. https://doi.org/10.1080/14767058.2022.2108857

Sotiriadis, A., Hernandez-Andrade, E., da Silva Costa, F., Ghi, T., Glanc, P., Khalil, A., Martins, W. P., Odibo, A. O., Papageorghiou, A. T., Salomon, L. J., & Thilaganathan, B. (2019). ISUOG Practice Guidelines: Role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound in Obstetrics & Gynecology, 53(1), 7-22. https://doi.org/10.1002/uog.19945

Verma, P., Desai, P., & Pathak, P. (2019). Study of color Doppler indices in high-risk pregnancies and perinatal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(9), 3693-3698. https://doi.org/10.18203/2320-1770.ijrcog20193797

Vollgraff Heidweiller-Schreurs, C. A., De Boer, M. A., Heymans, M. W., Schoonmade, L. J., Bossuyt, P. M. M., Mol, B. W. J., De Groot, C. J. M., & Bax, C. J. (2018). Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 51(3), 313-322. https://doi.org/10.1002/uog.18809

Yadav, H., & Lee, N. (2023). Prevalence of intrauterine growth restriction and its association with maternal risk factors in rural North India: A community-based study. BMC Pregnancy and Childbirth, 23(1), 167. https://doi.org/10.1186/s12884-023-05478-9

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Published

2025-04-09

How to Cite

1.
Khatoon S, Modi B, Shukla AK, Sharma AK, Ali A. Predictive Efficacy of Ultrasound Doppler Parameters in the Diagnosis of Intrauterine Growth Restriction and Associated Perinatal Outcomes in a Tertiary Care Setting. J Neonatal Surg [Internet]. 2025 Apr. 9 [cited 2026 May 30];14(13S):629-37. Available from: https://jneonatalsurg.com/index.php/jns/article/view/3339

Issue

Vol. 14 No. 13S (2025): Journal of Neonatal Surgery

Section

Original Article

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