Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study

2020 ◽  
Author(s):  
Danilo Buca ◽  
Giuseppe Rizzo ◽  
Sarah Gustapane ◽  
Ilenia Mappa ◽  
Martina Leombroni ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prospective Study ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Primary Outcome ◽  
Adverse Outcome ◽  
Perinatal Morbidity ◽  
Acid Base ◽  
Appropriate For Gestational Age ◽  
Acid Base Status

Abstract Objective To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term. Material and Methods Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10th and 90th percentile, at 36 + 0–37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data. Results 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor. Conclusion Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

Acid-Base Differences in Preterm and Term Twin Pregnancy

1991 ◽  
Vol 40 (3-4) ◽  
pp. 361-372 ◽  
Author(s):  
S.A. Ordorica ◽  
I.A. Hoskins ◽  
B.K. Young
Keyword(s):  
Blood Flow ◽  
Prospective Study ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
Time Interval ◽  
Blood Gas ◽  
Acid Base ◽  
Acid Base Status ◽  
A Prospective Study ◽  
Route Of Delivery

AbstractA prospective study was undertaken which examined 179 sets of twins, 68 premature (less than 36 weeks of gestation) and 111 term. The purpose of this study was to assess differences in the acid-base status between twins related to gestational age, birth order and the time interval between twin births. Although the twin blood-gas data is within the range considered normal, statistically significant differences favoring the first-born were noted for both preterm and term twins. These differences do not depend on gestational age, route of delivery or presentation, and become evident when the interval between twin births exceeds one minute. We postulate that after delivery of the first twin, the reduced uterine size causes a decrease in the intervillous blood flow and consequently a reduction in the respiratory exchange between the second fetus, still in utero, and its placenta.

Correlation between fetal Doppler indices and neonatal acid–base status at birth in healthy appropriate for gestational age term fetuses

2019 ◽  
Vol 300 (6) ◽  
pp. 1827-1830
Author(s):  
Nicola Fratelli ◽  
Valentina Benedetta Brunelli ◽  
Vera Gerosa ◽  
Enrico Sartori ◽  
Andrea Lojacono ◽  
...  
Keyword(s):  
Gestational Age ◽  
Acid Base ◽  
Fetal Doppler ◽  
Appropriate For Gestational Age ◽  
Acid Base Status ◽  
Doppler Indices

scholarly journals A study of maternal and perinatal outcome in cases of HELLP and partial HELLP syndrome

2017 ◽  
Vol 6 (12) ◽  
pp. 5491 ◽  
Author(s):  
Kanchan Durugkar
Keyword(s):  
Prospective Study ◽  
Hellp Syndrome ◽  
Perinatal Outcome ◽  
Liver Enzymes ◽  
Severe Preeclampsia ◽  
Perinatal Morbidity ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Laboratory Investigations ◽  
In Pregnancy

Background: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The objective of the present prospective study is to study on incidence, diagnosis, and variable presentations of HELLP syndrome in preeclampsia to analyse the severity and complications, as it is associated with maternal, perinatal morbidity and mortality. HELLP syndrome is difficult to diagnose when it presents with atypical clinical features.Methods: In the prospective study of 300 admitted cases with more than 20 weeks of gestation, were having preeclampsia. The selected cases were analyzed clinically with relevant history, clinical data and detailed laboratory investigations made for better analyses of complications and outcome in HELLP syndrome.Results: Under further clinical diagnosis of 300 cases of preeclampsia, 34 cases (11.33%) were of HELLP Syndrome and 44 (14.66%) cases were of partial HELLP syndrome. The present study shows 2.9% maternal mortality in HELLP and 4.5% in partial HELLP syndrome. Perinatal mortality was 17.6% with HELLP and 25% with partial HELLP.Conclusions: The diagnosis of HELLP syndrome has been made as a severe variant and complication of severe preeclampsia and eclampsia. It needs early diagnosis, timely intervention to arrest further progress and complications like multi organ dysfunction, renal failure, DIC, abruption etc and to improve maternal and perinatal outcome.

scholarly journals Effect of oral L- arginine versus intravenous hydration on maternal and fetal outcome in idiopathic oligohydramnios

2021 ◽  
Vol 10 (5) ◽  
pp. 1943
Author(s):  
Suhail Iqbal ◽  
Mehak Ayub Malik ◽  
Heena Kaurani ◽  
Divya Chauhan
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Normal Growth ◽  
Fetal Outcome ◽  
Perinatal Morbidity ◽  
Inclusion Criteria ◽  
Amniotic Fluid Index ◽  
Intravenous Hydration

Background: Adequate amount of amniotic fluid was required for normal growth of fetus. Oligohydramnios or reduced amount of amniotic fluid is associated with adverse maternal and perinatal outcome due to increase in induced labour and operative deliveries. Idiopathic oligohydramnios is a condition in which no other risk factors are associated with pregnancy. This study was done to compare the effect of L-arginine and IV hydration on improvement of amniotic fluid index and fetal growth.Methods: Total 50 patients were included in the study according to inclusion criteria and divided equally into two groups randomly. IV hydration was given to one group and other group received L- arginine sachet orally. The effect on AFI and fetal outcome was compared.Result: The result was compared with respect to age, gravidity, gestational age and AFI at the time of study and after giving treatment. Maternal and fetal outcome was compared which shows that L-arginine was more effective in increasing the AFI and thereby leading to favorable results in the form of increase in gestational age at time of delivery and fetal weight.Conclusion: This study shows that both IV hydration and L-arginine are useful in treatment of oligohydramnios. But L-arginine appears more advantageous over IV hydration in improving pregnancy outcome and reducing perinatal morbidity and mortality.

Neurological Outcome in Preterm Small for Gestational Age Infants Compared to Appropriate for Gestational Age Preterm at the Age of 18 Months: A Prospective Study

2009 ◽  
Vol 25 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Paraskevi Karagianni ◽  
Maria Kyriakidou ◽  
Georgios Mitsiakos ◽  
Helias Chatzioanidis ◽  
Emmanouel Koumbaras ◽  
...  
Keyword(s):  
Prospective Study ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Neurological Outcome ◽  
Appropriate For Gestational Age ◽  
A Prospective Study

scholarly journals Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

2018 ◽  
Vol 7 (6) ◽  
pp. 2455
Author(s):  
Shivali Bhalla ◽  
Seema Grover Bhatti ◽  
Shalini Devgan
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
North India ◽  
Care Hospital ◽  
Perinatal Morbidity

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.

scholarly journals Prediction of adverse effects of preeclampsia

2020 ◽  
Vol 9 (11) ◽  
pp. 4420
Author(s):  
Khushboo Tongaria ◽  
Ashok Kumar ◽  
Simar Kaur
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Adverse Outcome ◽  
Neurological Complication ◽  
Normal Pregnancy ◽  
Adverse Outcomes ◽  
Normal Outcome ◽  
Gestational Age At Delivery ◽  
Study Population ◽  
Lost To Follow Up

Background: To predict the adverse maternal, perinatal and combined (both maternal and perinatal) outcome in preeclampsia by using various clinical and laboratory variables. Methods: Five hundred fifty women diagnosed with preeclampsia were included and twenty-four women were excluded from the study due to exclusion criteria, six women decline to participate, twenty women were lost to follow up, three women withdrew consent, so a total of 497 women were followed up in the study.Results: Mean age of study population was 26.82±4.48 years. Majority of women with preeclampsia delivered vaginally. Forty-five (9.05%) developed neurological complication. Mean gestational age at delivery (weeks) in patients who developed adverse outcome was 34.58±3.74 weeks and in patients with normal outcome is 38.62±1.59 weeks. Mean birth weight of newborns were 2.1±0.73 kg and 1.85±0.61 kg for newborns with adverse outcomes. Majority of perinatal complication was small for gestational age 267 (54.37%) followed by prematurity 262 (53.36%). Total number of adverse perinatal events was six hundred seventy-seven as multiple neonates had more than one perinatal outcome. In combined (both maternal and perinatal) adverse outcome-374 (75%) developed adverse outcome, 123 (25%) developed normal pregnancy outcome.Conclusion: This study found out simple clinical, biochemical tools for monitoring pregnant women and accurately identifying who was at greatest risk of severe complications. By identifying those women at highest risk of adverse maternal outcomes well before that outcome occurs, transportation and treatment can be targeted to those women most in need. This clinical prediction tool found to be an important contributor as it offers the potential to improve health outcomes of women for a condition that is at the root of a large amount of morbidity and mortality in the developing world.

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