Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in sub-Saharan Africa

Abstract

Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation.

Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea.

Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The mean cerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days.

Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension.

Keywords: Ultrasonography, Doppler, pre-eclampsia, intrauterine growth restriction