The Role of Umbilical Artery Doppler in Predicting the Fetal Out Come in Cases of Pregnancy Induced Hypertension

Authors

  • Mohammed Ismail Syed
  • MV Ramanappa
  • Janardhan Reddy K
  • Aditya y

Abstract

Purpose: To determine and compare the diagnostic performance of Doppler sonography of fetal umbilical artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre eclampsia. Materials and Methods: 100 women with singleton pregnancy between 26 to 30 weeks of gestation were studied in this prospective study over a period of one and half years with color Doppler. UA flow velocity form was studied. In UA systolic/diastolic (S/D) ratio, pulsatility index (PI) and Resistance index (RI) were studied. In UA absent diastolic flow or reversed diastolic flow is noted. Results: Out of 50 clinically suspected pregnancy induced hypertension (PIH) cases, 31 (62%) cases show abnormal PI, 40 (80%) cases show abnormal RI values and 45 (90%) cases show abnormal S/D Ratio’s. Sensitivity and specificity of the S/D ratio in predicting PIH are 90% and 88% respectively followed by positive and Negative predictive value (PPV & NPV) of 88% and 89% whereas sensitivity, Specificity, PPV and NPV of RI & PI are lower than S/D ratio. This shows that S/D ratio has more Sensitivity, Specificity and Predictive values. Sensitivity of PI value in predicting fetal outcome is 75%. 22% (11 out of 50 cases) cases show absent/ reversal of end diastolic velocities, of these four are reversal of end diastolic velocity (RDEV). All four cases of REDV died before 32 weeks of gestation. Absent diastolic flow is seen in 7 cases, 4 cases died and three cases admitted in NICU with severe respiratory distress. Our study shows absent or reversal of end diastolic velocity is more sensitive in predicting adverse fetal outcome. There was no case of eclampsia or maternal death. Conclusion: UA flow velocity waveforms abnormality is more predictive for preeclampsia and IUGR. Hence Doppler is a promising tools in prediction of PIH and IUGR.

References

Fitz Gerald DE, Drumm JE. Noninvasive measurement of the fetal circulation using ultrasound: a new method. BMJ (1977). 2: 1450-51.

Report on Confidential Enquires into Maternal Deaths in the United Kingdom 1991-1993. London: HMSO (1996). pp. 20-31.

Maulik D, Nanda NC, Saini VD. Fetal Doppler echocardiography: methods and characterization of normal and abnormal hemodynamics. Am J Cardiol (1984). 53: 572.

Usha K, Tank DK, Daftary S. Pregnancy at risk current concepts. 4th ed. (2001). 257: 85.

Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr (1967). 71: 159.

Seeds JW, Peng T. Imapaired growth and risk of fetal death: is the tenth percentile the appropriate standard? Am J Obstet Gynecol (1998). 178: 658.

Campbell S, et al. New Doppler technique for assessing uteroplacental blood flow. Lacet (1983). 1: 675-77.

Williams RI, Creasy RK, Cunningham GC, Hawes WE, Norris MA, Tashro MS. Fetal growth and prinatal viability in California. Obstet Gynecol (1982). pp. 59624-632.

Bhushan N, Lakhkar, Shafeekahmed et al. The Doppler velocimetry of umbilical and uterine arteries during pregnancy. IJRI (1999). 9(3): 119-25. [10] Warsof SL, Cooper DJ, Little D et al. Sonographic estimation of fetal weight Radilogy (1987). 67: 33-39.

Thompson RS. Trudinger BJ, Cook CM. Doppler ultrasound waveform indices. AB ratio, Pulsatility index, and Pourcelot ratio Br J Obstet Gynecol (1988). 95: 581-88.

Trudinger BJ. Doppler ultrasonography and fetal wellbeing. In Reece EA, Hobbins JC, Mahoney M, Petirc RH eds. Medicine of the fetus and mother Philadelphia: JB lippincottt Co. (1992).

Fleischer A, Schulman H, Farmakides G, Bracero L, Blattner P, Randolph G. Umbilical artery waveforms and intrauterine growth retardation. Am J Obstet Gynecol (1985). 151: 502-505.

Beattie RB, Dornan JC, Antenatal screening for intrauterine growth retardation with umbilical artery Doppler ultrasonography. Br Med J (1989). 298: 631- 35.

M, Wendy Atkinson James, Maher, John Owen et al. The Predictive Value of umbilical Artery Doppler Studies for Preeclampsia or fetal growth retardation in a Preeclampsia prevention trial Obstet Gynecol (1994). 83: 609-12.

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Published

2014-11-17

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Original Research