Effect of maternal anaemia on foetal Doppler indices during third trimester of pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20223493Keywords:
Anaemia, Pregnant women, Doppler ultrasonographyAbstract
Background: Anaemia is amongst the most common medical disorders encountered during pregnancy all over the world. India has a high rate of anaemia in pregnant women. Anaemia has a recognizable effect on both maternal and foetal health during pregnancy and on perinatal outcome, contributing remarkably to maternal morbidity and mortality. Routine foetal monitoring is an essential investigation for such females with special emphasis on obstetrics Doppler ultrasonography. Various changes due to foetal hypoxia due to maternal anaemia can be remarkably appreciated on Doppler helping in timely management. The objective of this study was to evaluate the effect of maternal anaemia on foetal Doppler indices.
Methods: 400 pregnant women were assessed in a cross-section observational study done in the department of Radiodiagnosis in MYH, Indore, India. These women were divided into three groups of mild, moderate and severe anaemia based on the level of haemoglobin.
Results: Umbilical artery resistive and pulsatility indices were found to be increased with the increasing severity of anaemia while middle cerebral artery indices and CPR showed a decreasing trend with the increasing severity of anaemia.
Conclusions: We found that severe maternal anaemia is associated with marked adaption in foetal haemodynamics. Obstetrics Doppler can be used as an accurate measure of surveillance for foetal monitoring and will help in appropriate management.
References
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol. 2008;112(1):201-7.
Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, et al. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health. 2010;10:329.
National Family Health Survey. Factsheet NFHS 5 publications (2019-2021), 2021. Available at: http:FHS5_FCTdhya_Pradesh.
Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Family Med Prim Care. 2017;6(4):739-43.
Sinha A, Adhikary M, Phukan JP, Kedia S, Sinha T. A study on anemia and its risk factors among pregnant women attending antenatal clinic of a rural medical college of West Bengal. J Family Med Prim Care. 2021;10(3):1327-31.
Stefanović M, Milosavljević M, Radović-Janošević D, Kutlešić R, Vukomanović P. Maternal anemia and fetal cerebral hemodynamic response-Doppler assessment. Med Biol. 2005;12(2):93-6.
Singh R, Singh AK, Gupta SC, Singh HK. Correlates of anemia in pregnant women. Indian J Community Health. 2015;27(3):351-5.
Lumbanraja SN, Yaznil MR, Siregar DIS, Sakina A. The Correlation between Hemoglobin Concentration during Pregnancy with the Maternal and Neonatal Outcome. Open Access Maced J Med Sci. 2019;7(4):594-8.
Kessous R, Aricha-Tamir B, Weintraub AY, Sheiner E, Hershkovitz R. Umbilical artery peak systolic velocity measurements for prediction of perinatal outcome among IUGR fetuses. J Clin Ultrasound. 2014;42(7):405-10.
Abdel SAS, Bosilah AM, Farouk RA. Adverse effect of Maternal Anemia on Fetal Doppler Indices and estimated fetal weight during the Last trimester of pregnancy in rural and suburban area. Fayoum University Medical Journal. 2021;8(2):29-38.
Ghada A, Yossra S. Effect of maternal iron deficiency anemia on fetal cerebral hemo-dynamic response by Doppler and APGAR score. Med. J. Cairo Univ. 2012;80(2):235-40.
Rafiq S, Posh S, Jeelani I, Dar MA, Tang S. A study of fetal umbilical artery and middle cerebral artery Doppler velocimetry before and after treatment of severe maternal iron deficiency anaemia. New Indian JOBGYN. 2022;8(2):174-9.
Harneet N, Kapila AK, Kaur MM. Cerebral and umbilical arterial blood flow velocity in normal and growth retarded pregnancy. J Obstet Gynecol India. 2009;59(1):47-52.
Kurmanavicius J, Streicher A, Wright EM, Wisser J, Müller R, Royston P, et al. Reference values of fetal peak systolic blood flow velocity in the middle cerebral artery at 19-40 weeks of gestation. Ultrasound Obstet Gynecol. 2001;17(1):50-3.
Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(3):232-41.
Abdel-Megeed AM, Riad AA, Mohamed SM. Effect of maternal anemia on fetal Doppler indices during the last trimester of pregnancy. Evidence Based Women's Health J. 2019;9(1):356-62.
Ali A, Ara I, Sultana R, Akram F, Zaib MJ. Comparison of perinatal outcome of growth restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. J Ayub Med Coll Abbottabad. 2014;26(3):344-8.
Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 2000;342(1):9-14.
Ali E, Kumar M, Naqvi SE, Trivedi SS, Singh A. Fetal vascular adaptation before and after treatment of severe maternal anemia in pregnancy. Int J Gynaecol Obstet. 2016;133(3):284-6.
Ebbing C, Rasmussen S, Kiserud T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol. 2007;30(3):287-96.
Mari G, Deter RL. Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses. Am J Obstet Gynecol. 1992;166(4):1262-70.
Tarzamni MK, Nezami N, Sobhani N, Eshraghi N, Tarzamni M, Talebi Y. Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms. BMC Pregnancy Childbirth. 2008;8:50.
Komwilaisak R, Saksiriwuttho P, Ratanasiri T, Kleebkaow P, Seejorn K. Pulsatility index of the middle cerebral artery in normal fetuses. J Med Assoc Thai. 2004;87(3):S34-7.
Bano S, Chaudhary V, Pande S, Mehta V, Sharma A. Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. Indian J Radiol Imaging. 2010;20(1):20-5.
Shahinaj R, Manoku N, Kroi E, Tasha I. The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prenat Med. 2010;4(2):17-21.
Vergani P, Roncaglia N, Locatelli A, Andreotti C, Crippa I, Pezzullo JC, et al. Antenatal predictors of neonatal outcome in fetal growth restriction with absent end-diastolic flow in the umbilical artery. Am J Obstet Gynecol. 2005;193(3 Pt 2):1213-8.