الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
One of the most challenging areas currently facing obstetricians is the detection and management of pregnancies in which the growth of the fetus is poor. There is little doubt that these fetuses experience not only increased rates of perinatal morbidity and mortality but also higher levels of morbidity extending into adult life. As many as 40 per cent of so-called unexplained stillbirths are small for gestational age (SGA), leading to the suggestion that early detection and timely delivery may well prevent many fetal deaths.
Fetal growth restriction (FGR) is not synonymous with SGA. The best definition of intrauterine growth restriction (IUGR) is failure of a fetus to reach its genetic growth potential. Thus the umbilical artery Doppler study appears to assist clinicians in distinguishing constitutionally small infants from those with FGR.
Growth-restricted fetuses or small fetuses with low 5-minutes Apgars score have a higher risk of stillbirth and mortality than appropriately grown fetuses of a similar gestation. They are more at risk of hypothermia, hypoglycemia, pulmonary hemorrhage, infection encephalopathy and necrotizing enter colitis compared with normally grown babies of a similar gestation.
The problems of the small fetus do not end at birth or soon after birth but continue well into childhood and adulthood, the affected fetuses predispose to develop cardiovascular, metabolic, and endocrine disease years later.
These antenatal testing modalities aim to detect fetal compromise by evaluating fetal manifestations of altered oxygenation and metabolic status. Doppler ultrasonography and biophysical profile scoring (BPS) are the principal surveillance tools in pregnancies complicated by placental vascular insufficiency and fetal growth restriction (IUGR), but fetal deterioration appears to be independently reflected in these two testing modalities: their combined use is likely to be complementary.
In the IUGR fetus detected after 30 weeks of gestation with abnormal umbilical artery Doppler, a senior obstetrician should be involved in determining the timing and mode of birth of these pregnancies. Delivery should be offered at 37 weeks of gestation if UA EDV is still present. While in AREDV, delivery is planned after 34 wks.
In this present study, 42 pregnant woman diagnosed with late onset IUGR during the 3rd trimester scan (after 30 wks) were monitored. Fetal outcome was determined by neonatal weight, Apgar score and NICU admission.
According to UA Doppler finding, patients were categorised into group I, II:
group I: Umbilical artery Doppler indices > 2 SD for that gestational age. But umbilical artery had forward diastolic flow.
group II: Absent/Reversed End Diastolic Flow (AREDV).
When baby outcome in terms of birthweight were analysed with umbilical artery Doppler indice, there is significant difference between the groups. When the umbilical artery Doppler diastolic flow showed good forward diastolic flow it results in better outcome in terms of birthweight of more than 2 kg.
Summary
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In this study, fetal outcome was determined by 5-min APGAR score, NICU admissions, Birth weight and neonatal mortality.
When the umbilical artery diastolic flow worsens from good diastolic flow to absent or reversal of flow, the early neonatal death increases from 0% to 20%.
The babies admitted to NICU had variable diagnoses from Respiratory distress syndrome (RDS), Meconium Aspiration Syndrome (MAS), neonatal hypoglycemia and Poor suckling.
Overall perinatal mortality in this study is 7.14% which all are early neonatal mortality. Perinatal morbidity is 38%. When the diastolic flow in the umbilical artery is absent or reversed, it is associated with increased perinatal mortality.