Third Trimester IUGR Predictors and its Obstetric Outcome

Abstract

INTRODUCTION Intrauterine growth restriction (IUGR) of the foetus is defined as the inability of a foetus to reach its genetically determined growth potential at a given gestational age that means the birth weight is below the 10th percentile or birth weight less than 2 standard deviations for that gestational age. IUGR is a major source of perinatal morbidity and mortality and this continues to pose a challenging problem for both the obstetrician and paediatrician. MATERIALS AND METHOD SOURCE OF DATA: This prospective observational study was undertaken Dhiraj Hospital from 1stFebruary 2016 to 31st July 2017. INCLUSION CRITERIA: All singleton pregnant patients with vertex presentation (after 34 weeks of gestation) undergoing regular antenatal check-up (with accurate dates, which were substantiated by first trimester dating scan were enrolled) of which the cases were diagnosed of Late onset IUGR were taken and followed till delivery. EXCLUSION CRITERIA: Autoimmune disease Eclampsia XI Exposure to drugs, alcohol, nicotine abuse Multiple pregnancy Malpresentation Constitutionally small babies Congenital malformations STUDY DESIGN: The enrolment of women for this study was performed after having confirmed IUGR. This was done by • History • Clinical examination • Ultrasonography • Clinical examination of newborn • Pregnancy outcome record RESULT: The prevalence of Late onset IUGR diagnosed in our institution was 2.44%. Majority of women (54.84 %) were in the age group 25-29 years. All (100 %) of the women belonged to the lower middle and lower socioeconomic status. Majority (85.48 %) women had weight gain in pregnancy less than 8 kilograms. All IUGR patients had estimated foetal weight less than 10th percentile appropriate to that gestational age. The most prevalent risk factors were anaemia and gestational hypertension. In our study, out of 62 patients, 26 patients had AFI≤5, of which 13 foetuses had NICU admission and 30 patients from our study had abnormal CTG of which 15 foetuses had NICU admission. Out of 62 patients of our study, 12 patients had abnormal Ut AXII PI of which 4 foetuses had mortality. This suggests a strong association of Ut A-PI with neonatal mortality.25 patients in our study had MCA-PI abnormal and 12 out of these delivered by caesarean section. 64.52 % of patients underwent caesarean delivery. There was decrease in morbidity of newborn as the gestational age advances. 100 % babies had birth weight less than 2 kilograms. There was 6.45 % (4 foetuses) mortality in our study. There was no significant difference in maternal and neonatal morbidity in terms of mode of delivery (caesarean delivery/vaginal delivery). Birth asphyxia was found to be a major cause of NICU admission. CONCLUSION: Weight gain seems to be a very strong prognostic factor in terms of association with IUGR, so diagnosis of decrease in weight gain should be made at an earliest and efforts should be made towards adequate weight gain in pregnancy. Ut A-PI shows promising results in predicting severe foetal compromise. Our study suggests a strong co-relation of mortality with altered Ut A-PI. Late onset IUGR still remains a dilemma and it is difficult to predict, diagnose and even more difficult to manage.