Background:

The placenta plays a pivotal role in fetal growth, and its insufficiency can lead to IUGR. Multiple doppler ultrasound parameters such as umbilical artery pulsatility index (UMB-PI), middle cerebral artery pulsatility index (MCA-PI), Ductus venous (DV) and Cerebro Placental Ratio (CPR) are is use to identify and grade placental dysfunction.(4) These parameters, while informative, may not capture the subtleties of early cardiac dysfunction in IUGR.

The fetal heart undergoes adaptive changes in response to placental insufficiency, with the left ventricle and left atrium being particularly sensitive to alterations in blood flow. Recent studies have suggested that PV-PI, may serve as a more direct and sensitive indicator of left atrial dynamics, potentially offering a better understanding of early cardiac dysfunction in IUGR cases.(5)

Objective:

This study aims to compare various PVPI and UA-PI, between Intrauterine Growth Restricted Fetuses (IUGR) and Appropriate For Gestational Age (AGA) fetuses. By conducting a comparative analysis, we seek to discern which Doppler parameters exhibit greater sensitivity and specificity in predicting IUGR and early cardiac dysfunction.

Materials and Methods:

A prospective observational study was conducted between April 2023 and october 2023 at the Department of Radiodiagnosis, Bhaarath Medical College, Selaiyur, Chennai.

The study included a total of 105 singleton fetuses, divided into two groups:

• Group 1 (28 to 32 weeks diagnosed with early onset IUGR, n = 35) and
• Group 2 (28 to 32 weeks with Appropriate for Gestational Age (AGA), n = 70).

Early onset IUGR was defined as fetus with gestational age less than 32 weeks showing any one of the below mentioned features

• Estimated fetal weight (EFW) less than 3^rd percentile
• Abdominal circumference (AC) less than the 3^rd percentile
• EFW less than 10^th percentile with AC less than 3^rd percentile
• UA PI more than 95^th percentile for the gestational age.(6,7)

Doppler indices were correlated with subsequent fetal growth parameters, birth weights, and neonatal outcomes to ascertain predictive value and comparative efficacy.

Inclusion Criteria: all singleton pregnancies in the early 3^rd trimester (between 28 to 32 weeks of gestation)

Exclusion criteria : multiple pregnancies, congenital malformations, and pregnancies with chronic medical disorders, pregnancy outside the selected gestational weeks

Approval from the institutional research review board and ethical committee was obtained to ensure the ethical conduct of the study. Ultrasound and Doppler measurements were performed using GE voluson P8 machine with curved transducers. PVPI was obtained through fetal echocardiography, and other Doppler parameters such as UMB-PI, MCA-PI and CPR were also measured.

Pulmonary vein Doppler was assessed by placing the Doppler sample volume (sample volume of 0.7mm) at either the right superior  or inferior pulmonary vein as close to heart in a 4-chamber view. The PV-PI was calculated by measuring peak systolic velocity, presystolic velocity, and mean averaged maximum velocity. The cut off value was assigned as 0.96 for the PVPI based on previous study and the diagnostic accuracy was compared with umbilical artery in the diagnosis of IUGR.(8)

Statistical Analysis was made using spss software. Descriptive analysis and diagnostic testing accuracy was assessed.