Evaluation of Fetal Cerebral Flow Perfusion using 3D Power Doppler Ultrasound Angiography (3D-PDA) in Growth-Restricted Fetuses in Diabetic and Hypertensive Pregnant Patients

Abstract

SUMMARY I ntrauterine growth restriction (IUGR) is a syndrome characterized by a deficiency of fetal growth compared to the normal standards for the gestational age (GA). IUGR affects approximately 3 to 7% of all pregnancies. The growth restricted fetus is at increased risk for morbidity and mortality, it is estimated that perinatal mortality is 5-10 times higher in growth restricted fetus than those of the same GA and appropriate size. These infants are at high risk of perinatal hypoxia, acidemia, operative delivery, neonatal encephalopathy and other neonatal problems including hypoglycemia, hypothermia, hypocalcaemia and polycythemia. IUGR results from several causes including fetal causes (eg Chromosomal abnormality, Congenital malformation, STORCH infection, multifetal gestation and choronic placental abruption) and maternal causes (eg poor maternal weight gain, smoking, alcohol intake, addiction, choronic disease eg hypertension and diabetes with pregnancy). Growth restriction occurs with significant frequency in pregnant women with preexisting type 1 diabetes but it can occar in type 2 diabetes especially if there is underlying maternal vascular disease (eg retinal or renal vasculopathies and/or chronic hypertension). Intensive glycemic control (especially in diabetics with IUGR due to placental vascular insufficiency) may deprive fetus from nutrition. Secondly frequent hypoglycemia which are inevitable complication of insulin treatment may further worsen the IUGR.