Role of umbilical artery Doppler velocimetry in predicting the adverse perinatal outcomes in hypertensive disorder of pregnancy

Background: Early detection of fetoplacental compromise with Umbilical Artery Doppler indices and to know the predictive value of each indices in predicting perinatal outcome and interventional strategies in these patients.Methods: The present prospective study was conducted on 200 women with hypertensive disorder of pregnancy. Umbilical artery doppler evaluation done in all the patients at (28-32) weeks, (33-36) weeks and (37-40) weeks of gestation and more frequently in those patients having deranged Doppler. Patients divided into two groups women with abnormal Umbilical artery indices (group B) and normal indices (group A). Perinatal outcome of both the groups were compared, analyzed statistically using Chi-square test. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: A total of 200 pregnant women with hypertensive disorder, 64% were primgravida. Abnormal umbilical artery indices seen in 36%. Adverse outcome was seen in 88.88% patients of group B. Statistically significantly higher rate of caeserian section, induction of labour, Preterm delivery, fetal growth restriction, NICU admission, NICU stay >48hrs were seen in group B. In all indices Umbilical artery PI had highest Sensitivity (84.21%), positive predictive value (88.88%) and accuracy (90%).Conclusions: Umbilical artery PI is the most reliable to predict adverse perinatal outcomes and help in appropriate timing of intervention to improve perinatal outcome.

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Perinatal Outcome of Monochorionic Twins With Selective IUGR Compared With Uncomplicated Monochorionic Twins

Twin Research and Human Genetics ◽

10.1375/twin.14.5.457 ◽

2011 ◽

Vol 14 (5) ◽

pp. 457-462 ◽

Cited By ~ 21

Author(s):

Boaz Weisz ◽

Liat Hogen ◽

Yoav Yinon ◽

Liat Gindes ◽

Alon Shrim ◽

...

Keyword(s):

Perinatal Outcome ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Monochorionic Twins ◽

Group A ◽

Umbilical Artery Doppler ◽

Group B ◽

A Prospective Study ◽

Gestational Age At Birth ◽

Twin Pregnancies

Objective: To evaluate the perinatal outcome of MC twins with selective IUGR (sIUGR).Study design: A prospective study, which included three groups of MC twins: Group A, uncomplicated MC twin pregnancies (n = 91); group B, sIUGR with normal umbilical artery Doppler (n = 19); and group C, sIUGR with abnormal (absence or reversed EDV) umbilical artery Doppler (n = 18). The latter were routinely hospitalized in the high-risk ward under strict surveillance.Results: Neonatal outcome of fetuses complicated with sIUGR and normal Doppler was similar to controls. Neonates born to pregnancies complicated by sIUGR and abnormal Doppler had significantly increased incidence of CNS findings, RDS, NEC, sepsis, and neonatal death compared to controls. Adverse outcome in this group was independently associated only with gestational age at birth.Conclusion: The perinatal outcomes of MC twins complicated with sIUGR and normal Doppler are similar to uncomplicated MC pregnancies. MC twins with sIUGR and abnormal Doppler have reasonable outcomes, yet significantly more neonatal complications compared to non-complicated MC twins.

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Doppler interrogation of fetoplacental circulation in hypertensive disorder of pregnancy and their perinatal outcomes

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172471 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2687 ◽

Cited By ~ 2

Author(s):

Jyoti Devi ◽

Devender Kumar ◽

Mala Shukla ◽

P. K. Jain3

Keyword(s):

Umbilical Artery ◽

Perinatal Outcomes ◽

Control Group ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Diastolic Flow ◽

Hypertensive Group ◽

Hypertensive Disorders ◽

Significant Difference ◽

Hypertensive Disorder Of Pregnancy

Background: Hypertensive disorders of pregnancy are one of the major causes of maternal morbidity-mortality leading to 10-15% of maternal deaths especially in developing areas of the world. The Doppler examination makes it possible by providing a unique, non-invasive and safe method of studying blood flow characteristics in both the fetoplacental and uteroplacental circulations that is being used in clinical evaluation of high risk pregnancies. The aim was to study early detection of fetoplacental compromise in hypertensive disorder of pregnancy with Doppler indices and to know its role in predicting perinatal outcomes and interventional strategies in these patients.Methods: This prospective study was conducted on 100 subjects, 50 patients in study group with hypertensive disorders and 50 patients in control group with normotensive pregnancy. Doppler studies of umbilical and middle cerebral artery done and parameters recorded were systolic/diastolic ratio, pulsatility index and resistance index at 28-37 weeks of gestation. Perinatal outcomes of both groups compared, analyzed statistically. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: Statistically significant difference in the incidence of induction of labour (p=0.012) and caesarean delivery (p=0.049), preterm delivery (p=0.004), low birth weight (p=0.003), low apgar score (p=0.045) and NICU admission in the patients with abnormal umbilical artery doppler of hypertensive group were seen .66.66% and 100% perinatal mortality seen in absent end diastolic flow and reverse end diastolic flow of umbilical artery in hypertensive group respectively.Conclusions: Abnormal umbilical artery had highest sensitivity 76% and positive predictive value 84% in predicting adverse perinatal outcome and MCA Doppler having highest specificity 96% to exclude the false positive results of abnormal UA. The sequential study of both vessels useful in predicting interventional strategies and improving perinatal outcomes.

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Adverse Perinatal Outcomes Associated with Stage 1 Hypertension in Pregnancy: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0041-1739470 ◽

2021 ◽

Author(s):

Elizabeth Norton ◽

Frances Shofer ◽

Hannah Schwartz ◽

Lorraine Dugoff

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Hypertensive Disorder ◽

Hypertension In Pregnancy ◽

Increased Risk ◽

Hypertensive Disorder Of Pregnancy ◽

Adverse Perinatal Outcomes ◽

Stage 1 ◽

In Pregnancy

Objective To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. Study Design We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP] 130–139/80–89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (<130/80 mm Hg) before 20 weeks of gestation. The primary outcome was any hypertensive disorder of pregnancy; secondary outcomes were indicated preterm birth and small for gestational age. Generalized linear models were used to compare risk of adverse outcomes between the groups. Results Of the 1,630 women included in the analysis, 1,443 women were normotensive prior to 20 weeks of gestation and 187 women (11.5%) identified with stage 1 hypertension. Women with stage 1 hypertension were at significantly increased risk for any hypertensive disorder of pregnancy (adjusted risk ratio [aRR]: 1.86, 95% confidence interval [CI]: 1.12–3.04) and indicated preterm birth (aRR: 1.83, 95% CI: 1.12–3.02). Black women and obese women with stage 1 hypertension were at increased for hypertensive disorder of pregnancy compared with white women and nonobese women, respectively (aRR: 1.32, 95% CI: 1.11–1.57; aRR: 1.69, 95% CI: 1.39–2.06). Conclusion These results provide insight about the prevalence of stage 1 hypertension and inform future guidelines for diagnosis and management of hypertension in pregnancy. Future research is needed to assess potential interventions to mitigate risk. Key Points

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Immediate Perinatal Outcome of Neonates with Maternal Hypertensive Disorders in Pregnancy

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v33i3.9252 ◽

2013 ◽

Vol 33 (3) ◽

pp. 190-195

Author(s):

Mahmuda Hassan ◽

Ferdousi Choudhury ◽

Marium Begum ◽

Hamidur Rahman ◽

Sayeba Akhter

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Perinatal Outcome ◽

Gestational Hypertension ◽

Positive Family History ◽

Normal Vaginal Delivery ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Hypertensive Disorders ◽

Hypertensive Disorder Of Pregnancy

Introduction: Hypertensive disorders of pregnancy seem to be one of the major causes of maternal morbidity and mortality leading to 10-15% of maternal deaths especially in the developing world. This study examines the perinatal outcome of neonates with mothers having hypertensive disorder of pregnancy. Materials and Methods: Seventy three mothers and their newborn babies were selected. Mothers with Gestational hypertension, preeclampsia, eclampsia, chronic hypertension, preeclampsia superimposed on chronic hypertension were included. Gestational diabetics (GDM), chronic maternal diseases, infant of diabetic mother (IDM), babies with major congenital malformations were excluded. Results: Thirty five mothers (47.9%) had regular antenatal check up (ANC) and 38 (52%) had irregular. Nineteen mothers (26%) were primipara and 54 (74%) were multipara. Forty four mothers (60%) had positive family history or had own history of hypertensive disorder during their previous pregnancy. 13 mothers (17.8%) had normal vaginal delivery (NVD), 60 mothers (82.19%) had lower uterine cesarean section (LUCS). 30 babies (41%) were admitted. 44 mothers (60%) had gestational hypertension, 21 had (28.6%) pre-eclamtic toxemia (PET), 3 had (4.1%) eclampsia, 5 had (6.8%) essential hypertension 3 of them subsequently developed PET. Mean maternal age 26.86 years, gestational age 34.15 (±1.46)weeks among admitted and 36.30 (±1.6)weeks among non-admitted group. Mean birth weight was 1.69 (±0.39) kg. among admitted and 2.71 (±0.31) kg. in non-admitted babies. Seven pregnancies (9.58%) were twin, macerated 1 twin among was among 2 pregnancies (2.7%), 5 intra uterine death (IUD) observed in single pregnancy. Conclusion: Significant number of babies with maternal hypertensive disorder of pregnancy needed hospitalization, mean birth weight and gestational age was less than that of the non-admitted group. DOI: http://dx.doi.org/10.3126/jnps.v33i3.9252 J. Nepal Paediatr. Soc. 2013;33(3):190-195

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Significance of umbilical artery doppler velocimetry in the perinatal outcome of growth restricted fetuses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180895 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1074

Author(s):

Jyothi Susan Thomas ◽

A. Malliga ◽

S. Sethurajan

Keyword(s):

Perinatal Outcome ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Significant Rise ◽

Growth Restriction ◽

Doppler Velocimetry ◽

Perinatal Complications ◽

Chi Square ◽

Chi Square Test ◽

Umbilical Artery Doppler

Background: The objectives of the study are to determine the relationship between the umbilical artery Doppler and perinatal outcome in growth restricted foetuses and to compare the outcome with those of normal foetuses.Methods: A prospective observational study in which subjects were divided into two groups, pregnancies affected with intrauterine growth restriction (IUGR) and pregnancies with normal fetuses. Both the groups were followed with Doppler velocimetry of umbilical artery after 28 weeks till delivery. The perinatal outcome of both the groups with normal and abnormal umbilical artery Doppler (reduced/ absent/ reversed end – diastolic flow) were analysed with Chi-square test and student t - test using SPSS software version 15.0.Results: Umbilical artery Doppler velocimetry showed significant abnormality in growth restricted foetuses in comparison to normal foetuses. There was significant increase in the delivery of IUGR foetuses <37 weeks gestation(p<0.05). There was a significant increase in operative deliveries in both the groups with abnormal umbilical artery Doppler. A significant rise in adverse perinatal outcomes, Apgar <7 at 5 min and low birth weight in IUGR foetuses in comparison to normal foetuses (p<0.05).Conclusions: There is a strict correlation between abnormal umbilical artery Doppler velocimetry and an increased incidence of perinatal complications in growth restricted foetuses compared to normal foetuses. Hence, umbilical artery Doppler velocimetry should be used in all patients with fetal growth restriction, to identify impending hypoxia, to optimise the time of delivery and to optimise the perinatal outcome in these patients.

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119: Adverse perinatal outcomes in discordant twins with abnormal umbilical artery Doppler velocimetry

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2011.10.137 ◽

2012 ◽

Vol 206 (1) ◽

pp. S65-S66

Author(s):

Hilary Roeder ◽

Lynlee Wolfe ◽

Neha Trivedi ◽

Gladys Ramos ◽

Mana Parast ◽

...

Keyword(s):

Umbilical Artery ◽

Perinatal Outcomes ◽

Doppler Velocimetry ◽

Umbilical Artery Doppler ◽

Adverse Perinatal Outcomes ◽

Discordant Twins

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A study of role of doppler in gestational hypertension and perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203341 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3458

Author(s):

Anjali R. Chavda ◽

Parul T. Shah ◽

Rina V. Patel ◽

Hemali N. Patel

Keyword(s):

Blood Flow ◽

Doppler Ultrasound ◽

Perinatal Outcome ◽

Uterine Artery ◽

Umbilical Artery ◽

Gestational Hypertension ◽

Doppler Imaging ◽

Hypertensive Disorder ◽

Umbilical Artery Doppler

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index <1 and 27 cases had cerebro-placental index >1. Cases with cerebro-placental index <1 had various complications like preterm delivery, low birth weight, increased chances of still birth, intra uterine death (IUD), increased NICU admission. In this study 31 cases had abnormal uterine artery Doppler which accounts for 62% of total cases, while 38% had normal uterine artery Doppler.Conclusions: Doppler ultrasound can reliably predict any adverse fetal outcome in hypertensive pregnancies and can be a useful tool for decision making in appropriate timing of intervention for delivery.

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Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽

10.3390/v13050853 ◽

2021 ◽

Vol 13 (5) ◽

pp. 853

Author(s):

Sara Cruz Melguizo ◽

María Luisa de la Cruz Conty ◽

Paola Carmona Payán ◽

Alejandra Abascal-Saiz ◽

Pilar Pintando Recarte ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Outcomes ◽

Preterm Births ◽

Hypertensive Disorder ◽

Obstetric Emergency ◽

Increased Risk ◽

Emergency Group ◽

Adverse Perinatal Outcomes ◽

Maternal Disease ◽

The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

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The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0399 ◽

2020 ◽

Vol 48 (4) ◽

pp. 317-321

Author(s):

Rodney McLaren ◽

Bharati Kalgi ◽

Chima Ndubizu ◽

Peter Homel ◽

Shoshana Haberman ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Repeated Measures ◽

Adverse Outcome ◽

Perinatal Outcomes ◽

Low Risk ◽

Doppler Velocity ◽

Chronic Hypertension ◽

Adverse Perinatal Outcomes

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

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