scholarly journals OPTIMIZING PERINATAL OUTCOME IN HIGH RISK PREGNANCIES USING DOPPLER VELOCIMETRY

2015 ◽  
Vol 4 (95) ◽  
pp. 16064-16068
Author(s):  
Savithri D R ◽  
Pallavi R ◽  
Reethu Varadarajan ◽  
Veena B T
2019 ◽  
Vol 8 (17) ◽  
pp. 1408-1411
Author(s):  
Kavya G. Venkatappa ◽  
Sowbhagyalakshmi K. S. ◽  
Shivaprasad Shivaprasad ◽  
Kavana G. V ◽  
Geetha H. N

Author(s):  
Hymavathi K. ◽  
Prasuna P. ◽  
Davuluru Sandhya Rani

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.


Author(s):  
Maneesha R. Suryavanshi ◽  
Shriraj S. Katakdhond

Background: Doppler ultrasound provides a non-invasive method of studying the status of various blood vessels. It provides a spectrum analysis of the velocities of moving red blood cells. Doppler sonography can provide useful information in a variety of gynecological and obstetric conditions. In obstetrics, Doppler velocimetry of the uteroplacental and fetoplacental circulation can be used to further investigate complications of pregnancy such as fetal growth restriction, other forms of fetal distress that result from fetal hypoxemia or asphyxia.Methods: In a prospective observational study, 93 pregnancies fitting in the criteria for high risk were evaluated by doppler velocimetry between 28-40 weeks of gestation. The flow velocity time wave forms were examined and quantitated by use of systolic/diastolic (S/D) ratio, resistance index (RI), pulsatility index (PI) values. The outcome of pregnancy was noted.Results: Fetuses with abnormal velocimetry are at higher risk with regard to birth weight, Apgar score, fetal distress, need of cesarean section, need of NICU admission. The patients with absent end-diastolic flow (AEDF)/reversal of end-diastolic flow (REDF) had poor perinatal outcome. Positive predictive value for small for gestational age (SGA) and fetal distress was 75% and 60% respectively. 23.8% babies needed to be kept in neonatal intensive care unit (NICU).Conclusions: Doppler velocimetry can be useful prenatal test for the patients of hypertensive disorder of pregnancy and IUGR. Abnormal doppler waveform changes indicate adverse perinatal outcome. Appropriate and timely interventions guided by doppler study help to reduce perinatal morbidity and mortality.


Author(s):  
Nishi Choudhury ◽  
Barun Kumar Sharma ◽  
Bikram Kishor Kanungo ◽  
Ruby Yadav ◽  
Hafizur Rahman

Background: High risk pregnancies increase the maternal and fetal morbidity and mortality; and there is a need for appropriate investigation which can diagnose it early and predicts the morbidity and mortality. The objectives of this study were to compare the efficacy of Doppler velocimetry studies and NST in predicting fetal compromise in utero and compare their ability in predicting the perinatal outcome in cases of high risk pregnancies.Methods: It was a prospective cross-sectional hospital based study conducted at Central Referral Hospital (CRH) which is a teaching hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS). The study was conducted over a period of eighteen months between November 2012 and April 2014. One hundred consecutive cases of high risk pregnancies were enrolled into the study and investigated with NST (non-stress test) and Doppler velocimetry and results were correlated with perinatal outcome. In all cases, accurate gestational age was established from detailed menstrual history and ultrasonographic evidence of gestational age. Detailed examination, history and investigation were undertaken in each patient. Inclusion criteria were patients with singleton pregnancy beyond 34 weeks having one or more high risk factors. In these patients antenatal surveillance was done by Doppler and NST and results of these tests were correlated with perinatal outcome. Based on the Doppler velocimetry and NST results, the study population was divided in to four groups. Pregnant women below 34 weeks, multiple pregnancy and women with no risk factors were excluded from the study.Results: Maximum (63%) patients belonged to pregnancy induced hypertension (PIH) group, followed by oligohydramnios (11%), and gestational diabetes mellitus (GDM). The study showed that patients with both NST and Doppler waveform abnormal (group D) had the highest percentage of neonatal complication, NICU admissions and perinatal deaths. Even those patients with NST normal but Doppler velocimetry abnormal (group B) had comparatively higher neonatal complications. However, in group with NST abnormal and Doppler velocimetry normal (group C) had no fetal compromise. It was observed that normal NST and normal Doppler velocimetry were not statistically different in predicting fetal compromise and prediction value was low. But abnormal Doppler had statistically significant (p value = 0.021) predictive value in detecting fetal compromise. In cases with abnormal Doppler and fetal compromise, NST was still normal showing that abnormal Doppler waveform was better in predicting the bad perinatal outcome. Three out of 100 cases had absent end diastolic flow (AEDF) and all 3 were associated with perinatal morbidity with 2 perinatal deaths. Cerebroplacental ratio was < 1.08 in seven cases and all seven had neonatal complications including 3 neonatal deaths which also had AEDF. Thus, cerebroplacental ratio was better in detecting fetal compromise as compared to NST.Conclusions: Doppler velocimetry was better in predicting fetal compromise in comparison to NST in high risk pregnancies. Normal NST and normal Doppler velocimetry were not significantly different in prediction of fetal outcome. Abnormal Doppler value was better in predicting fetal compromise in comparison to abnormal NST.


2020 ◽  
Vol 16 (1) ◽  
pp. 52-59
Author(s):  
Naina Kumar ◽  
Himani Agarwal

Background: Placenta plays a very important role in the growth and development of fetus. Objective: To know the correlation between placental weight and perinatal outcome in term antenatal women. Methods: Present prospective case-control study was conducted in the rural tertiary center of Northern India over one year (January-December 2018) on 1,118 term (≥37-≤42 weeks) antenatal women with singleton pregnancy fulfilling inclusion criteria with 559 women with high-risk pregnancy as cases and 559 low-risk pregnant women as controls. Placental weight, birth weight was measured immediately after delivery and compared between the two groups along with gestation, parity, fetal gender, and neonatal outcome. Statistical analysis was done using SPSS 22 version. Results: Mean placental weight [481.98±67.83 gm vs. 499.47±59.59 gm (p=.000)] and birth weight [2.68±0.53 Kg vs. 2.88±0.4 Kg (p=.000)] was significantly lower in high risk as compared to lowrisk participants, whereas placental birth weight ratio was higher in high-risk cases [18.35±2.37 vs. 17.41±1.38 (p=.000)] respectively. Placental weight was positively correlated with birth weight and placental weight and birth weight increased with increasing gestation in both cases and controls. Male neonates had higher placental weight [492.74±68.24 gm vs. 488±58.8 gm (p=0.224)] and birth weight [2.81±0.5 Kg vs. 2.74±0.45 Kg (p=0.033)] as compared to females. Neonatal Intensive Care Unit admission was significantly associated with low placental and birth weight (p=.000). Conclusion: There is a significant correlation between placental weight, birth weight and neonatal outcome, hence placental weight can be used as an indirect indicator of intrauterine fetal growth.


2021 ◽  
Vol 6 (2) ◽  
pp. 185-191
Author(s):  
Hiral Parekh ◽  
Sneha Chaudhari

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of <28 weeks to >35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.


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