SMALL FOR GESTATIONAL AGE FETUS

ROLE OF COLOUR DOPPLER ULTRASOUND IN THE MANAGEMENT

Abstract

Objective: To evaluate the role of Colour Doppler Ultrasound in the management of small for
gestational age fetus. SGA or IUGR. Design: Descriptive study. Place & duration of study: Study performed in the
Deptt. of Radiology & Deptt. of Gynae. & Obstetrics in Allied Hospital, Faisalabad from August 2005 to July 2006.
Material & Methods: This study was carried out on 45 patients admitted through antenatal clinic having suspicion of
carrying small for gestational age fetus. A brief clinical record including age, parity, nutritional status, intercurrent illness,
per-vaginum bleeding, history of drug intake, smoking, past obstetrical history was recorded. Methods involved in
screening SGA fetuses were measurement of Symphyseal Fundal Height chart & Ultrasound biometry, Biophysical
profile (BPP), Cardiotocography (CTG), Middle cerebral and Umbilical Arteries Doppler studies were performed after
admission in the management of SGA fetuses. All these information were recorded in a specially designed Performa.
Results: Out of 45 SGA fetuses 15(33.3%) were constitutionally small, 20(44.4%) had history of pre-eclampsia,
2(4.4%) had cardiac disease, 3(6.6%) had placental abnormalities, 5(11.1%) had multiple gestations. Gestation of
patients ranged between 30-36 weeks. Umbilical Artery Doppler was used as the primary surveillance tool. Small
fetuses with normal Doppler and anomaly scan were managed on out-patient basis with fortnightly Doppler ultrasound.
15 patients (33.3%) with normal end-diastolic flow were delivered at 37 weeks. 20 patients (44.47%) with absent or
reversed end-diastolic flow were delivered at 34-35 weeks. 10 patients (22.2%) at 30 weeks gestation with abnormal
Doppler study were managed on CTG (Cardiotocography) & biophysical profile over a period ranging between 1-14
days. Perinatal mortality was 8.8% (4 cases) mostly due to extreme prematurity. Conclusion: Doppler ultrasound is
a very helpful tool in the management of small for gestational age fetuses & it reduces perinatal morbidity & Mortality.