![]() ![]() Samrakshan utilizes an opportunistic screening approach focused on pregnant women seeking imaging services at departments of clinical radiology at hospitals, clinics, and diagnostic centers. In this manuscript, we present the diagnostic effectiveness of individual abnormal fetal Doppler parameters with late- and-term stillbirths and neonatal deaths in a cohort of pregnant women screened in the third trimester of pregnancy using the Samrakshan protocols. Samrakshan is an ongoing national program of the Indian Radiological and Imaging Association (IRIA) started in July 2019 that integrates trimester-specific fetal Doppler studies with routine antenatal ultrasound studies to determine a customized risk assessment of preterm PE and FGR for each pregnant woman. However, there is a lack of information on the effectiveness of these components to identify FGR in India. This recent information led to the integration of UtA PI, CPR (includes both UA and MCA PI) and estimated fetal weight (EFW) < third percentile as core components of the diagnosis of FGR. The uterine artery (UtA) PI can be abnormal even in the presence of a normal UA PI and predict poorer perinatal outcomes. The cerebroplacental ratio (CPR) is more sensitive to hypoxia than UA or middle cerebral artery (MCA) PI and has a better correlation with adverse perinatal outcomes. Previous studies have reported that a significant proportion of fetuses with normal UA pulsatility indices (PI) have worse outcomes than fetuses with normal growth. However, UA Doppler indices have limitations as they may not pick up a mild placental disease. The poor perinatal health in India is exacerbated by the high prevalence of pre-eclampsia (PE), fetal growth restriction (FGR), and preterm births in India.Īn estimated 8 to 10% of pregnant women in India develop PE during pregnancy and an estimated 3.5 million children are born preterm every year.įetal Doppler studies help to ascertain hemodynamic redistribution suggestive of fetal adaptation to undernutrition/hypoxia, placental disease, higher risk of PE, and distinguish FGR from small for gestational age (SGA) babies.Ĭonventionally, the umbilical artery (UA) has been used to identify FGR with an abnormal UA Doppler study predicting poorer outcomes among small fetuses. India has a declining perinatal mortality rate that is still very high relative to the global rates. The effectiveness of fetal Doppler to identify pregnant women at high risk for term SB and neonatal deaths needs further study on a larger sample size. Integration of fetal Doppler with routine third-trimester antenatal scans can help identify pregnant women at high risk for late SB. The AUROC of Doppler measures was excellent for late SB but did not show discriminatory ability for term SB or neonatal deaths. ![]() Mean UtA PI, umbilical artery PI, MCA PI, and CPR were significantly associated with late SB and not term SB. An abnormal Doppler study was significantly associated with late stillbirths (OR 37.2, 95% CI: 2.05, 674) but not with term SB (OR: 3.38, 95% CI: 0.76, 15) or neonatal deaths (OR 1.39, 95% CI: 0.40, 4.87). Screening of 1,326 pregnant women in the third trimester of pregnancy between September 2019 and February 2022, identified 308 (23.23%) abnormal Doppler studies, 11 (0.83%) SB, and 11 (0.84%) neonatal deaths. Parameters of diagnostic effectiveness such as sensitivity, specificity, positive and negative predictive values and likelihood ratios, diagnostic odds ratio, and the area under receiver operator characteristic (AUROC) curve were assessed. ![]() Neonatal death was defined as the demise of a live-born baby within the first 28 days of life. Late stillbirth (SB) was defined as a fetal loss between 28 and 36 gestation weeks and the term SB was defined as a fetal loss at ≥ 37 gestation weeks. The results of the fetal Doppler study closest to childbirth were considered for analysis. The mean uterine artery (UtA) pulsatility index (PI) > 95th percentile, umbilical artery PI > 95th percentile, middle cerebral artery (MCA) PI < 5th percentile, and/or cerebroplacental ratio (CPR) < 5th percentile in the third trimester fetal Doppler study was considered as abnormal. To determine the diagnostic effectiveness of third-trimester fetal Doppler studies in pregnancy for stillbirths and neonatal mortality in the Samrakshan program of the Indian Radiological and Imaging Association (IRIA). ![]()
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