Placental MRI and Doppler Indices as Risk Stratification Indicators in High Risk Pregnancies

Abstract

Fetal growth restriction is one of the most challenging problems in obstetrics. It is detrimental to the health of both mother and baby. It is well known that neonates who have not reached their growth potential in utero, are at increased risk to health throughout their life. It is also complicated by the fact that there are no clear cut diagnostic criteria to differentiate IUGR fetuses from small for gestational age, but normal fetuses. Lack of differentiation, will result in unwanted premature delivery of otherwise normal small for date fetuses. This may cause undue stress to both mother and fetus, who would have otherwise had a normal outcome. Accurate diagnosis and management of intrauterine growth restriction depends on a combination of tests. To accurately date the pregnancy by early fetal Biometry. To assess intrauterine growth curve by regular Biometry and identify IUGR fetuses. Among IUGR fetuses to identify high risk pregnancies and place them under close surveillance. To choose an appropriate time to deliver the fetus with minimal risk to mother and baby. This study has added knowledge to the existing data regarding imaging of placenta by Doppler and MRI. Additional evaluation of Retroplacental and Intraplacental arteries has been found promising in Intra-uterine Growth Retardation (IUGR). Regarding MRI new data about decreasing signal intensity of fetal liver with gestational age is exciting. The liver, the site of glygogen storage in healthy foetuses was found to be affected in IUGR foetuses as shown by significant correlation of AF/LIV ratios. This study gives an Indian perspective to the appearance of normal MR placental appearance at various gestational ages and its comparison with fetal growth restriction. High risk indicators for ultrasound, Doppler and MRI have been evaluated. The significance of placental signal intensity measurements and the derived ratios have been established in the analysis of perinatal mortality and morbidity. This data may be used as a reference for future studies.