Determinants of adverse perinatal outcome in high-risk women with abnormal uterine artery Doppler images

ABSTRACT Objective To determine the usefulness of uterine artery Doppler in evaluation of third trimester high-risk pregnancies in prediction of adverse perinatal outcome. Methods In this prospective study uterine artery Doppler parameters such as PI and early diastolic notch were recorded in a group of 60 high-risk pregnancies mainly consisting of pre-eclampsia and small for gestational age. Uterine artery score (UAS) was calculated from the Doppler parameters and a score ≥ 2 was considered abnormal. Perinatal outcome was then correlated to this score and compared with umbilical artery Doppler. Results Abnormal UAS was noted in 72% of the study group while umbilical artery Doppler was abnormal in only 35%. All the five perinatal deaths and high-rate of perinatal morbidity was observed when both uterine and umbilical artery Dopplers were abnormal. Perinatal morbidity parameters such as birth weight < 2 kg, gestational age < 34 weeks and NICU admission was significantly high in 23 women who had abnormal UAS with normal umbilical artery Doppler. In pregnancies beyond 34 weeks abnormal uterine artery Doppler was a better predictor of adverse outcome than umbilical artery Doppler. Conclusion Abnormal uterine artery Doppler is a reliable predictor of adverse perinatal outcome in high-risk pregnancies with preeclampsia and fetal growth restriction. Normal uterine artery Doppler in third trimester is reassuring. Thus inclusion of uterine artery Doppler along with umbilical artery Doppler in high-risk pregnancy in third trimester will improve fetal surveillance.

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Significance of obstetric Doppler studies in prediction of perinatal outcome in pregnancy induced hypertension

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172312 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2354 ◽

Cited By ~ 1

Author(s):

Pradip R. Gaikwad ◽

Manisha R. Gandhewar ◽

Nity Rose ◽

Vidyadhar Suryakar

Keyword(s):

Diagnostic Accuracy ◽

Doppler Ultrasound ◽

Predictive Value ◽

Perinatal Outcome ◽

Uterine Artery ◽

Pregnancy Induced Hypertension ◽

Doppler Studies ◽

Uterine Artery Doppler ◽

Adverse Perinatal Outcome ◽

Induced Hypertension

Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel color Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler studies in PIH and to analyse its role in predicting perinatal outcome.Methods: This was a prospective study of 106 singleton pregnancies in the third trimester with PIH. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.Results: In the present study specificity and diagnostic accuracy of all Doppler ultrasound parameters was high in predicting adverse perinatal outcome. Cerebroplacental ratio showed highest specificity (98.55%), PPV (94.44%) and diagnostic accuracy (80.19%) in predicting adverse perinatal outcome and it is better than MCA PI and UA PI alone. Uterine artery Doppler evaluation also gives additional information in predicting adverse perinatal outcome.Conclusions: Amongst various Doppler parameters cerebroplacental index (MCA/UA PI) is best predictor of adverse perinatal outcome.

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