Progression Patterns of Doppler Parameters in Severe Fetal Growth Restriction

Fetal growth restriction (FGR) presents major challenges in obstetrics, particularly in India, where its occurrence is notably high. There is a lack of research on how Doppler parameters progress in severe FGR cases due to placental insufficiency, especially within the Indian setting.

This prospective observational study was conducted at a tertiary care hospital in India from 2020 to 2021, involving 40 pregnant women diagnosed with severe FGR. Serial Doppler evaluations were carried out on various maternal and fetal vessels, including the umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), umbilical vein, and uterine artery. Patients were followed until delivery, and perinatal outcomes were analyzed.

The results showed that:

Abnormalities in the umbilical artery pulsatility index (UA PI) progressed progressively, with early-onset cases experiencing a quicker decline.
Abnormalities in the uterine artery pulsatility index (UtA PI) were persistent, particularly in women with hypertension.
At delivery, all subjects exhibited MCA abnormalities, suggestive of brain-sparing effects.
Three distinct patterns of Doppler deterioration were identified based on the severity of placental insufficiency: mild, progressive, and severe early-onset.

To summarize, optimising perinatal outcomes in severe FGR pregnancies requires an understanding of the longitudinal evolution of Doppler abnormalities. Doppler parameter monitoring and early detection can help direct prompt treatments and enhance FGR management techniques. Additional research is needed to confirm these findings and assess their clinical significance comprehensively.

Source: Khatri N, Agarwal K, Aggarwal S, Puleria R, Changes in doppler parameters in severe fetal growth restriction and its association with perinatal outcomes in an Indian tertiary care centre. Indian J Obstet Gynecol Res 2025;12(1):48-54

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