Successful pregnancy Outcome in Pregnancy with severe placental insufficiency and IUGR.
                                   Dr.Samina Khurshid(MBBS.FCPS.MRCOG.1.CHPE)
.                                                            Dr.Saminakhurshid gynecologists @youtube.com.
 DIPLOMATE in IVF and Reproductive medicine(Germany).Diploma in Minimal Invasive Surgery(Germany)laparoscopic surge,
  A life-long member of SOGP.

 29 years old primigravida married for 1 yr.BMI  21.4 before conception. Booked at 25 weeks and 6 days of gestation with ultrasound report showing severe symmetrical IUGR with uteroplacental insufficiency along with the following parameters: AFI = 4.8cm Umbilical artery PI = 1.31 S.D ratio= 4.35(Upper normal range for that gestational age was 4.0).Right uterine artery PI =2.06. S.D ratio= 5.52.Left uterine artery PI = 1.11. S.D ratio = 2.59. A diastolic notch was visualized in the waveform of both uterine arteries.EFBW was less than 3rd centile.

She was then admitted for fetomaternal monitoring and conservative management was done. She was given inj Aminovel 600 for 4 days along with IV hydration. Inj Clexane 40mg OD was given. The dose was started at 40mg and was slowly increased up to 80mg OD. Tab Loprin was also started at 75mg BD. Tab Anifed R was given at 10mg BD dose. The patient was discharged on Inj Clexane, Tab Loprin, Anifed R, CQ-10 100mg, and Tonics. She was also advised to increase her oral intake of fluids. She was also advised to increase her oral intake of fluids. The patient was then managed on an OPD basis and was called for weekly visits.

 At 28 weeks of gestation, she presented with a BP of 140/90 after which Tab.Methyldopa 250mg BD was started. With this management, her ultrasound report showed improvement by 28 weeks of gestation. Her AFI had increased to 10.75cm. The scan still shows uteroplacental insufficiency at this point. The right uterine artery showed elevated RI and SD ratio with B/L early diastolic notching. whereas, the umbilical artery showed standard S/D ratio and spectral waveform.

Further improvement was seen at the 30-week scan. Her AFI was 16cm and no resistance to umbilical artery flow was seen. B/L uterine artery also showed normal RIs. BPP was 10/10. There was thickened placental bulk and premature placental calcification. The fetal parameters were lagging behind by 4-5 weeks. Steroid cover completed at 32 weeks of gestation.

The scan report at 36 weeks then showed a reduced AFI of 6cm. Increased S/D ratio of 3.9 (suggestive of placental insufficiency- IUGR). BPP was 9/10. The patient was then admitted for EmLSCS. female baby of 1.33kg having Apgar scores of 8 and 9, with a good cry and no gross anomaly delivered. The placenta was sent for histopathology and its report showed no placental infarcts and pathology.