scholarly journals Foetal umbilical artery doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and foetal growth restriction

2017 ◽  
Vol 6 (5) ◽  
pp. 2060
Author(s):  
Amandeep Raj ◽  
Reema Kumar Bhat ◽  
S. Prajwal ◽  
Rao P. S.
Keyword(s):  
Mortality Rate ◽  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Perinatal Outcome ◽  
Color Doppler ◽  
Stress Test ◽  
Severe Preeclampsia ◽  
Adverse Perinatal Outcome ◽  
Foetal Growth ◽  
Foetal Growth Restriction

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome.Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out.Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates.Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.

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

2017 ◽  
Vol 6 (6) ◽  
pp. 2354 ◽  
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.

scholarly journals Serum uric acid as marker of severity of pre-eclampsia

2017 ◽  
Vol 6 (11) ◽  
pp. 4915 ◽  
Author(s):  
Shirish Toshniwal ◽  
Aakriti R. Lamba
Keyword(s):  
Multivariate Regression ◽  
Perinatal Outcome ◽  
Umbilical Artery ◽  
Neonatal Resuscitation ◽  
Resistive Index ◽  
Adverse Outcomes ◽  
Foetal Distress ◽  
High Relative Risk ◽  
Adverse Perinatal Outcome ◽  
Foetal Growth

Background: In pre-eclampsia, there is increased uteroplacental resistance and reduced foetal perfusion due to inadequate invasion of spiral arterioles by trophoblast cells. This causes impaired foetal growth and foetal hypoxia. To assess the usefulness of foetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio >2 standard deviation (SD) or UA - Pulsatility Index (PI) and UA - Resistive Index (RI) >2 SD were taken as abnormal. The middle cerebral artery (MCA) was visualised and cerebroumblical PI ratio calculated. MCA-RI <2SD was taken as abnormal.Results: There were 107 women in the study. Major adverse outcomes 11. Umbilical artery - S/D ratio >2SD (RR 4.46, 95%, CI 1.40-14.17) and RI >2SD (RR 3.36, 95%, CI 1.03-10.61) and MCA RI <2SD (RR 4.46, 95% CI 1.4-14.17) had a high relative risk to predict adverse major perinatal outcome. 39 babies were admitted in neonatal nursery and no parameters could predict them. Though UA - PI >2SD predicted acute foetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI >2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute foetal distress in labour or neonatal nursery admission could not be predicted.

Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction

2021 ◽  
pp. 1-6
Author(s):  
Ozge Kahramanoglu ◽  
Oya Demirci ◽  
Mucize Eric Ozdemir ◽  
Agnese Maria Chiara Rapisarda ◽  
Munip Akalin ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Late Onset ◽  
Growth Restriction ◽  
Foetal Growth ◽  
Foetal Growth Restriction

scholarly journals A prospective study to evaluate the role of routine early third trimester ultrasound in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome using color Doppler

2020 ◽  
Vol 9 (11) ◽  
pp. 4506
Author(s):  
Shabd Singh Yadav ◽  
Aditi Singh ◽  
Kalpana Yadav
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcome ◽  
Pulsatility Index ◽  
Color Doppler ◽  
Study Group ◽  
Third Trimester ◽  
Intrauterine Growth ◽  
Adverse Perinatal Outcome ◽  
Control Study

Background: Intrauterine growth restriction (IUGR) is a major and silent cause of perinatal morbidity and mortality. Rate of IUGR in developing countries is 6 times higher than that of developed countries. 14 to 20 million infants are affected with IUGR in developing countries annually. The highest incidence is found in south central Asia (33%) and India (21%). Aim of study was to evaluate the role of early 3rd trimester ultrasound in diagnosis and role of color Doppler in prediction of adverse perinatal outcome in IUGR.Methods: A prospective case-control study was conducted on 720 women admitted in GMH Rewa for one year. 360 antenatal cases diagnosed as IUGR on ultrasound were taken as study group, same number of non IUGR cases were taken as control. Study cases were followed with Doppler. The umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebro-placental ratio were calculated and the results were analysed.Results: Inferences drawn from the study were: rate of caesarean section was significantly higher (31%) in study group, perinatal outcome was poor in more number of cases (10.8%) in study group than the control group (3.4%), and the sensitivity and specificity of cerebroplacental ratio was more reliable indicator in comparison to that of UA PI and MCA PI in prediction of adverse perinatal outcome.Conclusions: Looking at the high burden of IUGR cases in our country and its adverse effects on perinatal outcome, if early third trimester ultrasound is made mandatory for all pregnant women, most of the IUGR cases can be detected and managed timely and perinatal outcome can be significantly improved.

scholarly journals Obstetric Doppler studies in prediction of perinatal outcome in intrauterine growth restriction

2018 ◽  
Vol 7 (10) ◽  
pp. 4177
Author(s):  
Pradip R. Gaikwad ◽  
Sarah Zaidi ◽  
Meenakshi Rana ◽  
Vidyadhar Suryakar
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Intrauterine Growth Restriction ◽  
Perinatal Outcome ◽  
Umbilical Artery ◽  
Doppler Studies ◽  
Colour Doppler ◽  
Intrauterine Growth ◽  
Adverse Perinatal Outcome

Background: Fetal surveillance of the pregnancies that are complicated by IUGR is essential to improve fetal outcome. Colour Doppler studies of uteroplacental and fetoplacental circulation are useful in identification of hypoxemic status of the fetus and allows timely intervention in at risk fetuses. The present study was aimed to know the significance of colour Doppler studies in intrauterine growth restriction cases and to correlate with the perinatal outcome thus to offer better strategies for early diagnosis of compromised fetus and timely intervention.Methods: This was a prospective study of 125 singleton pregnancies in the third trimester with IUGR. 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 63 patients had one or more adverse perinatal outcome parameter. The diagnostic accuracy of umbilical artery was more (71.20%) than other parameters in predicting adverse perinatal outcome. Middle cerebral artery RI was having highest specificity and positive predictive value of 100% than any other parameter in predicting adverse perinatal outcome. Patients with AEDF and REDF had 33.3% and 50% perinatal deaths respectively.Conclusions: Middle cerebral artery Doppler studies shown more specificity and positive predictive value than umbilical artery Doppler in prediction of adverse perinatal outcome.

Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance

2016 ◽  
Vol 44 (2) ◽  
Author(s):  
Ahmed Abobakr Nassr ◽  
Ahmed M. Abdelmagied ◽  
Sherif A.M. Shazly
Keyword(s):  
At Risk ◽  
Diagnostic Accuracy ◽  
Perinatal Outcome ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Apgar Scores ◽  
Neonatal Complications ◽  
Adverse Perinatal Outcome ◽  
Adverse Perinatal Outcomes

AbstractThe objective of this meta-analysis is to assess the value of fetal cerebro-placental Doppler ratio (CPR) in predicting adverse perinatal outcome in pregnancies with fetal growth restriction (FGR).Three databases were used: MEDLINE, EMBASE (with online Ovid interface) and SCOPUS and studies from inception to April 2015 were included. Studies that reported perinatal outcomes of fetuses at risk of FGR or sonographically diagnosed FGR that were evaluated with CPR were considered eligible. Perinatal outcomes include cesarean section (CS) for fetal distress, APGAR scores at 5 min, neonatal complications and admission to neonatal intensive care unit (NICU). Pooled data were expressed as odds ratio (OR) and confidence intervals (CI), and the summary receiver operating characteristic (SROC) curve was used to illustrate the diagnostic accuracy of CPR.Seven studies were eligible (1428 fetuses). Fetuses with abnormal CPR were at higher risk of CS for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. These risks were higher among studies that included fetuses diagnosed with FGR than fetuses at risk of FGR. Abnormal CPR had higher diagnostic accuracy for adverse perinatal outcomes among “sonographically diagnosed FGR” studies than “at risk of FGR” studies.Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

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