Correlation of doppler studies at 34 weeks of gestation with perinatal outcome in high risk pregnancies

Authors

  • Apoorva Reddy Department of Obstetrics & Gynecology, PGIMER & Dr. RML Hospital, Delhi, India
  • Renuka Malik Department of Obstetrics & Gynecology, PGIMER & Dr. RML Hospital, Delhi, India
  • Shibani Mehra Department of Obstetrics & Gynecology, PGIMER & Dr. RML Hospital, Delhi, India
  • Pushpa Singh Department of Obstetrics & Gynecology, PGIMER & Dr. RML Hospital, Delhi, India
  • Lakshman Ramachandran Department of Internal Medicine, Jaypee Hospital, Noida, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20151282

Keywords:

High risk pregnancy, Doppler, uterine artery, umbilical artery, middle cerebral artery

Abstract

Background: Antepartum detection of the fetus at risk of death or compromise in utero remains a major challenge in modern obstetrics. The waveform analysis of the feto- maternal circulation by Doppler ultrasound has therefore become a quick and a simple way of screening and identifying fetal compromise. The main objective of the study is to evaluate Doppler flow indices as an index for assessing fetal well being in high risk pregnancies and to determine the predictive value of various Doppler parameters with perinatal outcome.

Methods: The study was a prospective cohort study were forty pregnant women with a high risk factor (intrauterine growth restriction, pre eclampsia and gestational diabetes mellitus) and forty pregnant women with no high risk(controls) were selected at 34 weeks of gestation. Both the groups underwent an obstetrical ultrasound with color Doppler examination of bilateral uterine arteries, umbilical artery and middle cerebral artery. Abnormality was serially monitored and pregnancy terminated in the presence of absent, reversal of end diastolic flow in umbilical artery or non-reassuring tests of fetal wellbeing.

Results: Uterine artery S/D abnormality was seen in 32.5% of high risk cases were as abnormal umbilical artery S/D was seen in 25% and abnormal Pulsatility Index (PI) in 15% cases. Middle cerebral artery flow was abnormal in only 17.5% cases. Abnormality in the uterine artery flow correlated well with the incidence of preterm delivery (69.2%), need for cesarean section (53.8%) and length of Neonatal intensive care unit(NICU) stay >48 hours (69.23%). Abnormal umbilical artery flow was associated with a significant increase in the incidence of preterm delivery(75%), small for gestational age babies(93.75%) and length of NICU stay >48 hours (93.75%). There was no significant correlation seen with isolated abnormal middle cerebral artery flow.

Conclusions: Both uterine and umbilical artery Doppler velocities correlate well with the perinatal outcome but abnormal uterine artery Doppler predicts adverse neonatal outcome better than the fetal vessels as it discriminates fetuses at risk because of abnormal placental vascularisation from those who are at risk due to other causes.

References

Dubay P, Chaturvedi P. Doppler Waveform Analysis in High Risk Pregnancy. Asian J Obs Gynae Practice. 2003;7(5):23-6.

Konje JC, Abrams K, Bell SC, de Chazal RC, Taylor DJ. The application of color power angiography to the longitudinal quantification of blood flow volume in the fetal middle cerebral arteries, ascending aorta, descending aorta, and renal arteries during gestation. Am J Obstet Gynecol. 2000;182(2):393-400.

Giancarlo M. Doppler ultrasonography in obstetrics: from the diagnosis of fetal anemia to the treatment of intrauterine growth-restricted fetuses. Am J Obstet Gynecol. 2009;200(6):613.e1-613.e9.

Alexander GR, Himes JH, Kaufmann RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163.

Carpenter MW, Coustan DR .Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768-73.

Fleischer A, Schulman H, Farmakides G, Bracero L, Blattner P, Randolph G. Uterine artery waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151:502-5.

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. Sept 2005;193 (3):1213-8.

Cameron AD, Nicholson MD, Nimrod CA, Harder JR, Davies DM. Doppler waveforms in the fetal aorta and umbilical artery in patients with hypertension in pregnancy. Am J Obstet Gynecol.1988;158:339-45.

Harrington K, Carpenter RG, Nguyen M, Campbell S. Changes observed in Doppler studies of fetal circulation in pregnancies complicated by preeclampsia or delivery of a small for gestational age baby: Cross sectional analysis. Ultrasound Obstet Gynecol. 1995;6:19.

Ghi T, Youssef A, Piva M, Contro E, Segata M, Guasina F, et al. The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia. Am J Obstet Gynecol. 2009;201:36.e1-5.

Irion O, Masse J, Forest JC, Moutquin JM. Prediction of pre-eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women. BJOG. 1998;105:422-9.

Konje JC, Howarth ES, Kaufmann P, Taylor DJ. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. BJOG. 2003;110:301–5.

Vergani P, Roncaglia N, Andreotti C, Arreghini A, Teruzzi M, Pezzullo JC, et al. Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol. 2002;187(4):932-6.

Dubey P, Pandey K, Gupta N. Color Doppler evaluation of Uteroplacental Circulation in Management of High risk Pregnancies. Asian J Obs Gynae Practice. 2009;4:19-22.

Vergani P, Andreotti C, Roncaglia N, Zani G, Pozzi E, Pezzullo JC, et al. Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 weeks' gestation or beyond. Am J Obstet Gynecol. 2003;189(4):1007-11.

McCowan LME, Harding JE, Stewart AW. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. BJOG. 2000;107:916-25.

Gudmundsson S, Marsal K. Blood velocity waveforms in the fetal aorta and umbilical artery as predictors of fetal outcome: a comparison. Am J Perinatol. 1991;8:1–6.

Simanaviciute D, Gudmundsonn S. Fetal middle cerebral to uterine artery Pulsatility index ratios in normal and pre eclamptic pregnancies. Ultrasound Obstet Gynecol. 2006;28:794-801.

Harrington K, Thompson MO, Carpenter RG, Nguyen M, Campbell S. Doppler fetal circulation in pregnancies complicated by pre-eclampsia or delivery of a small for gestational age baby: 2. Longitudinal analysis. BJOG. 1999;106:453-66.

Redman CWG. Examination of the placental circulation by Doppler ultrasound. BMJ. 1989;298:621-2.

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2017-02-19

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