Role of dual biomarkers and uterine artery doppler study in predicting PIH and IUGR in antenatal patients registered in a tertiary care centre
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20210720Keywords:
Dual biomarkers, IUGR, PIH, Uterine artery doppler - resistivity index (UAD-RI)Abstract
Background: The incidence of IUGR is between 3 to 7%, whereas that of Hypertensive disorders of pregnancy is about 10% of pregnant women around the world. These conditions are associated with a high rate of perinatal morbidity and mortality, posing a need for the detection of the potential causes of maternal and foetal morbidity and mortality and for the prediction of these conditions early during pregnancy.
Methods: Patients with first antenatal visit before 10 weeks gestation underwent routine NT scan between 11–13 weeks with bilateral UAD-RI of the maternal uterine arteries. The placental volume was assessed. Serum dual biomarker test (β hCG and PAPP-A) was performed after this scan and analysed as multiples of median (MoM). Blood pressure was recorded at every ANC visit till 2 weeks after delivery. Neonatal head and chest circumference, birth length and weight were recorded.
Results: The mean values of PAPP-A levels of Non-PIH and PIH groups were 1.32±0.91 MoM and 0.68±0.39 MoM respectively, showing statistically significant difference. The serum PAPP-A levels showed statistically significant difference between Non-IUGR and IUGR groups (1.24±0.87 MoM and 0.46±0.20 MoM respectively).
Conclusions: In our study, PAPP-A level is observed as a good indicator for possible prediction of PIH and IUGR whereas levels of β hCG and UAD-RI were not good predictors. The role of Placental volume in prediction of IUGR needs to be explored further with larger sample size. Future studies are needed with a larger group with inclusion of measurement of PI values.
References
Vyas HG, Goyal RK, Vyas GM, Vyas BA, Shah SA. An Observational Study to Determine the Prevalence and Risk Factors Associated with Pregnancy Induced Hypertension in a Semi-Urban Town of India. The Indian Practitioner. 2017;70(12):16-20.
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24-43.
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384(9947):980-1004.
World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM. World Health Organization; 2012.
Dunn PM. The search for perinatal definitions and standards. Acta PaediatrScand Suppl. 1985;319:7-16.
Romo A, Carceller R, Tobajas J. Intrauterine growth retardation (IUGR): epidemiology and etiology. Pediatr Endocrinol Rev. 2009;6(Suppl 3):332-6.
Donald Ian; Practical obstetric problems. 7th edition, Wolters Kluwer India Pvt. Ltd; New Delhi, 2014: 339-352.
Xiong X, Mayes D, Demianczuk N, Olson DM, Davidge ST, Newburn-Cook C, Saunders LD. Impact of pregnancy-induced hypertension on fetal growth. Americ J Obstetr Gynecol. 1999 1;180(1):207-13.
Jurkovic DA, Jauniaux ER, Kurjak AS, Hustin JE, Campbell ST, Nicolaides KH. Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy. Obstetrics Gynecol. 1991;77(3):365-9.
Van den Elzen HJ, Cohen‐Overbeek TE, Grobbee DE, Quartero RW, Wladimiroff JW. Early uterine artery Doppler velocimetry and the outcome of pregnancy in women aged 35 years and older. Ultrasound in Obstetrics and Gynecology: The Official J International Society of Ultrasound in Obstetrics and Gynecol. 1995;5(5):328-33.
Harrington K, Goldfrad C, Carpenter RG. and Campbell S. Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre‐eclampsia and intrauterine growth retardation. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetr and Gynecol. 1997;9(2):94-100.
Korevaar TI, Steegers EA, de Rijke YB, Schalekamp-Timmermans S, Visser WE, Hofman A, Jaddoe VW, et al. Reference ranges and determinants of total hCG levels during pregnancy: the Generation R Study. European J Epidemiol. 2015;30(9):1057-66.
Patil M, Panchanadikar TM, Wagh G. Variation of papp-a level in the first trimester of pregnancy and its clinical outcome. J Obstetr Gynecol Ind. 2014;64(2):116-9.
Poon LC, Akolekar R, Lachmann R, Beta J, Nicolaides KH. Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11–13 weeks. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecol. 2010;35(6):662-70.
Poon LC, Maiz N, Valencia C, Plasencia W, Nicolaides KH. First‐trimester maternal serum pregnancy‐associated plasma protein‐A and pre‐eclampsia. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetr Gynecol. 2009;33(1):23-33.
Poon LC, Kametas NA, Maiz N, Akolekar R, Nicolaides KH. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension. 2009;53(5):812-8.
Stamnes KUM, Andersen FLE, Joergensen DKN, Stigum H, Nass O, Nystad W. Maternal pre‐pregnant body mass index, maternal weight change and offspring birthweight. Acta obstetricia et gynecologica Scandinavica. 2012;91(2):243-9.
Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res. 2014;23:4.
Berhe AK, Kassa GM, Fekadu GA, Muche AA. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC pregnancy and childbirth. 2018;18(1):34.
Gomez O, Martinez JM, Figueras F, Del Rio M, Borobio V, Puerto B, Coll O, Cararach V, Vanrell JA. Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound in Obstetr Gynecol. 2005;26(5):490-4.
Pedroso MA, Palmer KR, Hodges RJ, da Silva Costa F, Rolnik DL. Uterine artery Doppler in screening for preeclampsia and fetal growth restriction. Revista Brasileira de Ginecologiae Obstetrícia/RBGO Gynecol Obstetr. 2018;40(05):287-93.
Azpurua H, Funai EF, Coraluzzi LM, Doherty LF, Sasson IE, Kliman M, Kliman HJ. Determination of placental weight using two-dimensional sonography and volumetric mathematic modeling. American J Perinatol. 2010;27(02):151-5.
Shiefa S, Amargandhi M, Bhupendra J, Moulali S, Kristine T. First trimester maternal serum screening using biochemical markers PAPP-A and free β-hCG for down syndrome, patau syndrome and edward syndrome. Ind J Clinic Biochemist. 2013;28(1):3-12.
Bapat A. Role of Dual Biomarkers & Ut. artery Doppler study in predicting PIH & IUGR. Dissertation submitted to the Maharashtra University of Health Sciences; 2019.
Muti M, Tshimanga M, Notion GT, Bangure D, Chonzi P. Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC cardiovascular disorders. 2015;15(1):111.
Scandiuzzi RM, Prado CA, Araujo Júnior E, Duarte G, Quintana SM, da Silva Costa F, Tonni G, Cavalli RD, et al. Maternal uterine artery Doppler in the first and second trimesters as screening method for hypertensive disorders and adverse perinatal outcomes in low-risk pregnancies. Obstetr Gynecol Sci. 2016;59(5):347-56.
Abdel Moety GA, Almohamady M, Sherif NA, Raslana AN, Mohamed TF, El Moneam HM, et al. Could first-trimester assessment of placental functions predict preeclampsia and intrauterine growth restriction? A prospective cohort study. The Journal of Maternal-Fetal & Neonatal Medic. 2016;29(3):413-7.
Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). American J Obstetrics and Gynecol. 2004;191(4):1446-51.
Gardosi J. Intrauterine growth restriction: new standards for assessing adverse outcome. Best practice & research Clinic Obstetr Gynaecol. 2009;23(6):741-9.
Gardosi J. Customised assessment of fetal growth potential: implications for perinatal care. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2012;97(5):F314-7.
Popovski N, Nikolov A. Biomarkers for Early Detection of Hypertensive Disorders in Pregnancy: Current Applications and Future Directions-The Role of Extracellular Matrix. Biomedical J Scient Technic Res. 2019;16(2):1-3.
