DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181930

Serum Beta HCG and uterine artery Doppler studies in second trimester to predict preeclampsia and eclampsia

Nitin Kulkarni, Radhika Bansal, Pankaj Pawar

Abstract


Background: Hypertensive disorders during pregnancy remain amongst the most significant and intriguing unsolved problems in obstetrics. The study aims at testing the hypothesis that women with high serum beta hCG levels and alterations in waveforms in the uterine artery doppler in early second trimester have high risk of developing pre-eclampsia.

Methods: Serum Beta hCG estimation was done by Sandwich chemiluminescence immunoassay method. All uterine artery waveforms were obtained using a Toshiba nemio ultrasound machine attached to a 3.5 MHz curvilinear transducer, with colour and pulsed Doppler abilities.

Results: For prediction of preeclampsia or eclampsia uterine artery Doppler velocimetry alone shows specificity of 96.30%, sensitivity of 90%, positive predictive value of 94% and negative predictive value of 80%. When it is combined with serum beta HCG sensitivity and specificity are almost same, but alone serum beta HCG levels are showing sensitivity of 96% and specificity of just 76%.

Conclusions: Abnormal waveforms on uterine Doppler studies are the better predictors for preeclampsia and eclampsia when done in early second trimester.


Keywords


Beta HCG, Doppler velocimetry, Eclampsia, Prediction of preeclampsia

Full Text:

PDF

References


Cunningham, LB, Spong DH, Casey, Sheffield; Hypertensive disorders chapter 40; Williams obstetrics 24th edition, Mc Graw Hill Education, Newyork

Kaur Gumandeep, Jain Vimla, Mehta Seema, Himani Sunita; Prediction of PIH by Maternal Serum Beta HCG Levels in the Second Trimester (13-20 weeks) of Pregnancy. J Obstet Gynecol India. 2012;62:32-4

World Health Organization, Make Every Mother and Child Count, World Health Report,2005, World Health Organization, Geneva, Switzerland; 2005

Confidential Enquiry into Maternal and Child Health (CEMACH), Perinatal Mortality 2006. England, Wales and Northern Ireland, CEMACH, London, UK; 2008.

L.Dubey, “The global impact of pre-eclampsia and eclampsia,” Semi Perinatol. 2009;33:130-7.

Yu CK, Khouri O, Onwudiwe N, Spiliopoulos Y, Nicolaides KH. Prediction of pre‐eclampsia by uterine artery Doppler imaging: relationship to gestational age at delivery and small‐for‐gestational age. Ultrasound Obstet and Gynecol. 2008;31:310-3.

Witlin AG, Saade GR, Mattar F, Sibai BM. Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation. American J Obstet Gynecol. 2000;182:607-11.

Irgens HU, Roberts JM, Reisæter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort studyPre-eclampsia and cardiovascular disease later in life: who is at risk? BMJ. 2001;323:1213-7.

P.von Dadelszen, L.A. Magee, and J.M. Roberts, “Subclassification of Preeclampsia,” Hypertension Preg. 2003;22:143-8.

Hsu CD, Chan DW, Iriye B, Johnson TR, Hong SF, Repke JT. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. American J Obstet and Gynecol. 1994;170:1135-8.

Woschitz MC, Idris T, Csapo B, Haas J, Ulrich D, Lang U and Cervar-Zivkovic M; Uterine Artery Doppler in Women with History of Previous Pre eclampsia and women with Chronic Hypertension: Re-evaluation of a prognostic Value in a High Risk Population; Gynecol Obstet. 2004;4:2.

Park YW, Lim JC, Kim YH, Kwon HS. Uterine artery Doppler velocimetry during mid-second trimester to predict complications of pregnancy based on unilateral or bilateral abnormalities. Yonsei medical journal. 2005;46:652-7.

Sorensen TK, Williams MA, Zingheim RW, Clement SJ, Hickok DE. Elevated second-trimester human chorionic gonadotropin and subsequent pregnancy-induced hypertension. American J Obstet Gynecol. 1993;169:834-8.

Gökdeniz r, Arigüloğlu E, Bazoğlu N, Balat Ö. Elevated Serumbeta-hCG Levels in Severe Preeclampsia. Turkish J Med Sci. 2000;30:43-6.

Lieppman RE, Williams MA, Cheng EY, Resta R, Zingheim R, Hickok DE et al.,. An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. American journal of obstetrics and gynecology. 1993;168:1852-6.

Hsu CD, Chan DW, Iriye B, Johnson TR, Hong SF, Repke JT. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. American J Obstet Gynecol. 1994;170:1135-8.

Myatt L, Miodovnik M. Prediction of pre-eclampsia. Semin Perinatol. 1999;23:45-57.

Liu DF, Dickerman LH, Redline RW. Pathological findings in pregnancies with unexplained increase in mid trimester maternal serum human chorionic gonadotropin levels. Am J Clin Pathol. 1999; 111:209-15.

Robert JM. Pre eclampsia: what we know and what we do not know. Semin Perinatol. 2000;24:24-8.