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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(01): 028-035
DOI: 10.1055/s-0042-1759637
Original Article

Diagnostic Effectiveness of Third-Trimester Fetal Doppler Studies in Pregnancy to Predict Late-and-Term Stillbirth and Neonatal Mortality in the Samrakshan Program in India

Rijo Mathew Choorakuttil
1   Department of Clinical Radiology, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India
,
Shilpa R. Satarkar
2   Department of Clinical Radiology, Antarang Sonography and Colour Doppler Center, Satarkar Hospital, Aurangabad, Maharashtra, India
,
Lalit K. Sharma
3   Department of Clinical Radiology, Raj Sonography & X-Ray Clinic, Baiju Choraha, Nayapura, Guna, Madhya Pradesh, India
,
Anjali Gupta
4   Department of Clinical Radiology, Anjali Ultrasound and Colour Doppler Centre, Agra, Uttar Pradesh, India
,
Akanksha Baghel
5   Department of Clinical Radiology, Baghel Sonography Center, Harda, Madhya Pradesh, India
,
Eesha Rajput
6   Department of Radiology, INHS Asvini, Colaba, Mumbai, Maharashtra, India
,
Praveen K. Nirmalan 
7   Department of Research, Chief Research Mentor, AMMA Education and Research Foundation, AMMA Healthcare Research Gurukul, Kochi, Kerala, India
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Abstract

Aim 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).

Methods 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. The results of the fetal Doppler study closest to childbirth were considered for analysis. 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. Neonatal death was defined as the demise of a live-born baby within the first 28 days of life. 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.

Results 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. 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). Mean UtA PI, umbilical artery PI, MCA PI, and CPR were significantly associated with late SB and not term SB. The AUROC of Doppler measures was excellent for late SB but did not show discriminatory ability for term SB or neonatal deaths.

Conclusion Integration of fetal Doppler with routine third-trimester antenatal scans can help identify pregnant women at high risk for late SB. 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.

Keywords

diagnostic effectiveness - fetal Doppler - neonatal mortality - stillbirth


Publication History

Article published online:
07 December 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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