Pulsatility index and resistance index in the aortic bifurcation area of growth retarded fetuses

UNLABELLED: To specify diagnostic importance of fetoplacental flow parameters PI, RI during pregnancy complicated by ultrasonografically detected intrauterine growth retardation-IUGR. SETTING: Dpt. of Obstetric and Gynaecology, Safarik's University and University Hospital L. Pasteur, Kosice, Slovak Republic, Obst/Gynae Dpt., Victoria Hospital, Mahe, Seychelles Republic, Indian Ocean. SUBJECT AND METHOD: The autors measured fetal circulation on the level of descending aortal bifurcation. The results were compared in the Group-A of 112 pregnancies complicated by mild, moderate and several praeeclampsia, eclampsia with detected IUGR, and comparative Group-B of 106 pregnancies. INTERVENTION: The ACUSONIC 8, ALOKA 680 SSD using transabdominal 3.5 MHz probe with color doppler facility. The parameters were measured in weekly intervals according the clinical protocol for management of high risk pregnancies. SUBJECTS: There was opened a prospective comparative study of 112 risk pregnancies (Group-A) and a comparative Group-B of 106 pregnancies with normal growth of fetuses. Group-A was devided according classification of praeeclampsia to Subgroup-A1, mild praeeclampsia, Subgroup-A2, moderate praeeclampsia, Subgroup-A3, severe praeclampsia and Subgroup-A4, eclampsia. Parameters of vascular resistance in descending aorta were calculated from 28th week of gestation to termination of pregnancy and compared average values in corresponding stage in the Group-A and the comparative Group-B. Number of IUGR fetuses or restricted with the growth were calculated in Subgroups-A. RESULTS: Descending aorta presents significantly higher average values of PI, RI during pregnancy from 28th week of gestation in Group-A. There is no evidence of diastolic decrease after 34th week of gestation in Group-A. In Group-A 52.6% fetuses were ultrasonograficaly IUGR detected or restricted. In Subgroup-A1 of mild praeeclampsia were 20.5% of the IUGR fetuses. Subgroup-A2 of moderate praeeclampsia showed 51.3% and Subgroup-A3 severe praeeclampsia 87.8% of the IUGR fetuses of restricted. Three cases of eclampsia were restricted for growth. MAIN OUTCOME: Functional assessment of the descending aorta flow is the most reliable method for differentiation of praeclamptic and eclamptic pregnancies with suspected fetal starvation and intrauterine growth retardation.