Doppler study of umbilical and fetal middle cerebral artery in severe preeclampsia and intra uterine growth restriction and correlation with perinatal outcome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20174442Keywords:
Doppler, Intra-uterine growth restriction, Middle cerebral artery, Perinatal outcome, Preeclampsia, Umbilical arteryAbstract
Background: Pre-eclampsia and IUGR are two conditions resulting from defective trophoblastic invasion of spiral arteries and an increase in vascular resistance in uteroplacental circulation. Doppler offers a non-invasive tool for evaluation of fetoplacental blood flow and correlate with fetal compromise giving early warning sign of fetal distress.
Methods: The study was conducted in Command Hospital, Lucknow in 100 singleton pregnancies with vertex presentation between 28-40 weeks of gestation with severe preeclampsia and/or IUGR. Doppler analysis of UA and MCA was done. Pregnancies were terminated depending on clinical condition and Doppler results.
Results: Abnormal Umbilical artery S/D ratio had strong statistical correlation with poor perinatal outcome. Elevated RI had 100% sensitivity in predicting APGAR<7 at 5 minutes. Elevated PI values was statistically significant in all parameters (except NICU stay>48hrs) in predicting poor perinatal outcome. PI values had highest sensitivity for predicting low APGAR values and highest specificity for predicting NICU admission. AEDF and REDF also correlated with adverse perinatal outcome. MCA S/D ratio had a high sensitivity (96.8%) in determining NICU stay>48h and specificity (70%) in determining NICU admissions. RI had highest sensitivity (71.8%) for NICU stay >48hrs and highest specificity for predicting NICU admissions (76.5%). MCA PI had a sensitivity of 66.6% in determining APGAR<7 at 5min and a specificity of 78.7% in determining NICU admissions. CPR had the highest sensitivity (100%) among all indices.
Conclusions: The study showed an adverse fetal outcome in cases of severe preeclampsia and or IUGR which showed abnormal Doppler results and thereby help to determine the optimal time for delivery.
References
WHO. WHO International Collaborative study of Hypertensive disorders of pregnancy. Geographic variation in the incidence of Hypertension in pregnancy. Am J Obstet Gynecol. 1988;158:80-3.
Confidential Enquiry into maternal deaths: Why mothers die? 2000-2002. The sixth Report of the confidential Enquiries into maternal deaths in UK. London: RCOG Press;2004.
Pijnenborg R, Dixon G, Robertson WR, Brosens F. Trophoblastic invasion of human decidua from 8-18 wks of pregnancy. Placenta. 1980;1:3-19.
Kam EPY, Gardner L, Loke YW, King A. The role of trophoblast in physiological change in decidual spiral arteries. Human Reprod. 1999;14:2131-8.
Brosens IA. Morphological changes in the uteroplacental bed in pregnancy Hypertension. Clin Obstet Gynecol. 1977;4:573-93.
Kohnen G. Villous development and the pathogenesis of IUGR in intrauterine growth restriction. Br J Obstet Gynecol. 1990;99:342-8.
Porcelot L. Applications cliniques de I examen Doppler transcutane In: Perommeau P, ed. Velocimetric ultrasonoic Doppler. Paris: INSERM;1974:213-40.
Gudmundsson S, Maršál K. Umbilical artery and uteroplacental blood flow velocity waveforms in normal pregnancy: a cross‐sectional study. Acta Obstetr et Gynecologic Scandinavica. 1988;67(4):347-54.
Madazli R. Prognostic factors for survival of growth - restricted fetuses with absent end - diastolic velocity in the umbilical artery. J Perinatol. 2002;22:286-290.
Yoon Bh, Lee CM, Kim SW. An abnormal umbilical artery waveform; a strong and independent predictor of adverse perinatal outcome in patient with pre eclampsia. Am J Obstet Gynecol. 1994;171:713-721.
Trud1nger BJ, Cook CM. Doppler umbilical and uterine flow waveforms in severe pregnancy hypertension. Br J Obstet Gynecol. 1990;97:142-8.
Brar HS, Medearis AL, De Yore GR. A comparative study of fetal umbilical velocimetry with continuous and pulsed wave Doppler ultrasonography in high pregnancies its outcome. Am J Obstet Gynecol. 1989;160:375.
Yelikar KA, Prabhu A, Thakre GG. Role of Fetal Doppler and Non-Stress Test in Preeclampsia and Intrauterine Growth Restriction. J Obstet Gynecol India. 2013;63(3):168-7
Bhatt CJ, Arora J, Shah MS. Role of color Doppler in pregnancy induced hypertension (a study of 100 cases). Indian J Radiol Imaging. 2003;13:417-20.
Malhotra N, Chanana C, Kumar S, Roy K, Sharma JB. Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006;60:311-7.
Bano S, Chaudhary V, Pande S. 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.
Chalubinski KM, Repa A, Stammler-Safar M, Ott J. Impact of Doppler sonography on intrauterine management and neonatal outcome in preterm fetuses with intrauterine growth restriction. Ultrasound Obstet Gynecol. 2012;39(3):293-8.
Roy A, Mukherjee S, Bhattacharyya SK, Banerjee P, Das B, Patra KK. Perinatal outcome in pregnancies with intra-uterine growth restriction by using umbilical and middle cerebral artery colour Doppler. J Indian Med Assoc. 2012 Mar;110(3):154-7.
Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging. 2006;16:109-16.
Rani S, Huria A, Kaur R. Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices. Hypertens Pregnancy. 2016;35(2):210-6.
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 Prenatal Med. 2010 Apr;4(2):17.
