Comparison of ophthalmic artery Doppler indices among hypertensive and normotensive pregnant women in third trimester: association with perinatal outcomes

Authors

  • Madhuri Manchu Department of Fetal Medicine, Medicover Hospital, Vishakhapatnam, Andhra Pradesh, India
  • Geeta Vandana Reddi Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India; Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
  • Ravali Ranjith M. Swamy Eye Hospital, Vizianagaram. Andhra Pradesh, India; Department of Ophthalmology, Maharaja Institute of Medical Sciences, Vizianagaram. Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232274

Keywords:

Ophthalmic artery Doppler, Hypertension, Severe preclampsia, Peak systolic velocity, Peak ratio, Uterine artery Doppler

Abstract

Background: In this study, we compared ophthalmic artery Doppler indices between normotensive and hypertensive pregnant women in third trimester and then evaluated if the alterations in ophthalmic artery doppler indices were seen in all the types of hypertensions in pregnancy or confined to preclaampsia. Further we tried to see correlation of ophthalmic artery Doppler indices with perinatal outcomes in terms of fetal growth restriction (FGR), prematurity, neonatal intensive care unit admission (NICU) and maternal outcomes and tried to arrive at mean values of ophthalmic artery Doppler indices to predict adverse outcomes.

Methods: 50 hypertensive and 50 normotensive pregnant women were recruited in third trimester. A thorough history about hypertension was taken, obstetric scan was done to know estimated fetal weight, and doppler of umbilical, middle cerebral artery, uterine arteries was done. Simultaneously maternal ophthalmic artery Doppler readings were taken, women were followed up after delivery and perinatal outcomes were recorded.

Results: Comparison of mean values of ophthalmic artery doppler parameters in women with and without hypertension showed statistically significant differences with respect to the peak systolic velocity 2 (PSV2), PI (pulsatility index), RI (resistivity index) and peak ratio (PR) (PR=PSV2/PSV1). Significant difference was found only in PR value in preeclampsia group compared to other subgroups of hypertension. In the hypertension group complicated with FGR the mean peak ratio=0.8 whereas in the hypertension group requiring preterm delivery the mean peak ratio=0.78, and in the hypertension group requiring NICU admission the mean peak ratio=0.81. At ophthalmic artery PR cut off ≤0.725, the sensitivity and specificity were 76% and 65% respectively to predict FGR.

Conclusions: Pregnancy complicated by hypertension showed alterations in ophthalmic artery Doppler indices. Among the subgroups of hypertension, ophthalmic artery PR was the best index for discriminating preclampsia from other types and it was significantly higher in hypertensive pregnant women who had adverse perinatal outcomes. Ophthalmic artery PR has almost similar performance as uterine artery PI in indicating FGR in our study. It could also indicate maternal disease severity such as hypertensive crisis requiring ICU admission, the study number was small.

References

Manisha D, Kanchan G, Nishu J, Anjali M, Ajeet B, Smita S. Prevalence of hypertensive disorders of pregnancy in India: A systematic review and meta-analysis. J Med Evid. 2021;2:105.

Report of the National high blood pressure education program working group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):1-22.

Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. New York: McGraw Hill; 2010.

Townsend R, Khalil A, Premakumar Y, Allotey J, Snell KIE, Chan C, et al. Prediction of pre-eclampsia: review of reviews. Ultrasound Obstet Gynecol. 2019;54(1):16-27.

O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016;214(1):103.

Zeeman GG, Cunningham FG. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2014;210(4):378-9.

Zeeman GG. Neurologic complications of pre-eclampsia. Semin Perinatol. 2009;33(3):166-72.

Cattaneo P, Marchetti P, Bruno VD, Mariscalco G, Sala A. Color Doppler imaging of the ophthalmic artery during antegrade selective cerebral perfusion. Tex Heart Inst J. 2007;34(1):105-7.

Cipolla MJ, Liebeskind DS, Chan SL. The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation. J Cereb Blood Flow Metab. 2018;38(12):2129-49.

Kane SC, Khong SL, da Silva Costa F. Diagnostic Imaging: Ultrasound. Methods Mol Biol. 2018;1710:1-8.

Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol. 1999;180:499-506.

Redman CW. Current topic: pre-eclampsia and the placenta. Placenta. 1991;12(4):301-8.

Dennis AT, Castro JM. Hypertension and haemodynamics in pregnant women-is a unified theory for pre-eclampsia possible? Anaesthesia. 2014;69(11):1183-9.

Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia: an overview. Circulation. 2014;130(8):703-14.

Kampman MA, Bilardo CM, Mulder BJ, Aarnoudse JG, Ris-Stalpers C, van Veldhuisen DJ, et al. Maternal cardiac function, uteroplacental Doppler flow parameters and pregnancy outcome: a systematic review. Ultrasound Obstet Gynecol. 2015;46(1):21-8.

Matias DS, Costa RF, Matias B, Gordiano L, Correia LC. Ophthalmic artery Doppler velocimetric values in pregnant women at risk for preeclampsia. J Ultrasound Med. 2012;31(10):1659-64.

Carneiro RS, Sass N, Diniz AL, Souza EV, Torloni MR, Moron AF. Ophthalmic artery Doppler velocimetry in healthy pregnancy. Int J Gynaecol Obstet. 2008;100(3):211-5.

Sarno M, Wright A, Vieira N, Sapantzoglou I, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in prediction of pre-eclampsia at 35-37 weeks' gestation. Ultrasound Obstet Gynecol. 2020;56(5):717-24.

Onwudiegwu C, Adekanmi A, Olusanya B, et al Case-control study on ocular changes and ophthalmic Doppler velocimetric indices among preeclamptic and normotensive pregnant women in Ibadan, Nigeria BMJ Open ophthalmology 2020;5:e000550. doi: 10.1136/bmjophth-2020-000550

Gurgel Alves JA, Praciano de Sousa PC, Maia E Moura S, Kane SC, et al. First-trimester maternal ophthalmic artery Doppler analysis for prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2014;44(4):411-8.

Kalafat E, Laoreti A, Khalil A, Costa F, Thilaganathan B. Ophthalmic artery Doppler for prediction of pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(6):731-7.

Sapantzoglou I, Wright A, Arozena MG, Campos RV, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 19-23 weeks' gestation. Ultrasound Obstet Gynecol. 2021;57(1):75-83.

Matias DS, Costa RF, Matias BS, Gordiano L, Correia LC. Predictive value of ophthalmic artery Doppler velocimetry in relation to development of pre-eclampsia. Ultrasound Obstet Gynecol. 2014;44(4):419-26.

Matias DS, Santos R, Ferreira T, Matias BS, Correia LCL. Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy. J Clin Ultrasound. 2020;48(7):388-95.

Nicolaides KH, Sarno M, Wright A. Ophthalmic artery Doppler in the prediction of preeclampsia. Am J Obstet Gynecol. 2022;226(2S):1098-101.

Borges JH, Goes DA, de Araújo LB, Dos Santos MC, Diniz AL. Prospective study of the hemodynamic behavior of ophthalmic arteries in postpartum preeclamptic women: A doppler evaluation. Hypertens Pregnancy. 2016;35(1):100-11.

Oliveira CA, Moreira RA, Zamprogno KV, Gutierrez da Matta F, Araújo F. Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series. J Med Case Rep. 2017;11(1):326.

Downloads

Published

2023-07-28

Issue

Section

Original Research Articles