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    What does deranged umbilical artery dopplers during pregnancy?

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Posted on Sat, 31 Jan 2015 in Pregnancy
Question: Hi, I am writing to you on behalf of my wife, she is currently 33 weeks pregnant and we are carrying DCDA twins.
Doctor has prescribed ARG 9 (L - Arginine & Proanthocyanidin Granules) three times a day from today. This is because according to our latest Fetal scan done today it has been reported that the umbilical artery dopplers show an increased resistance to flow. The S/D ratio is over the 95th Centile for both fetuses.

In order to reduce the resistance of blood flow to the fetuses the doctor has asked us to take ARG 9.
I wanted to check with you if it is safe for us to consume this medicine, when we checked online we have various references that tell this is very harmful to the body and causes complications. It also mentions that this medicine interacts with blood thinner, however we have already been prescribed Asprin (75mg) from first trimester which is being currently consumed as well.

Can you please advice.
doctor
Answered by Dr. Sameer Kumar 26 minutes later
Brief Answer:
Its safe in pregnancy , explained

Detailed Answer:
Hello,
Thanks for contacting healthcaremagic.
In a DCDA twins and at 33 weeks , if the umbilical artery dopplers are deranged , the best way to manage is to regularly follow up with umbilical artery doppler every 3 days to ascertain the improvement and worsening of the flow , with an aim to plan delivery as close to 36 weeks .
If there is a reversal of umbilical artery blood flow anytime, the babies have to be delivered by c-section within 24 hrs to avoid any fetal demise. As its a twin pregnancy, it is likely that the fetal weights would also be less in a scenario of increased resistance flow. So ARG-9 is an enzyme product which has been used in various cases of IUGR and decreased umbilical artery blood flow to improve circulation and in the bargain the fetal weight so that they survive better when delivered.
Also the immediate aim is 34 weeks when the fetal lungs are said to be matured completely and the baby can breathe easily in the external environment. Studies have been done on ARG-9 in IUGR cases and the results were positive.

Usually in early pregnancy, ARG-9 is being given to increase the placental circulation, for better growth of baby and to reduce the chances of an early miscarriage. These can be safely used in pregnancy and may be continued till full term to avoid growth retardation and preterm labor.

ARG -9 is just a supplement and in not a replacement to regular umbilical artery doppler follow up every 3 days. Ultimately the resistive index would decide the delivery time and the would be mom has to be hospitalized ideally to be under constant medical supervision so that a DAILY NON STRESS TEST can also be performed to keep the well being of the fetuses under check.
The benefits of ARG9 when compared with the risks ( interaction with aspirin), still it scores and should be used.
regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1656 Questions

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