Doppler Velocimetry evaluation in high-risk pregnancy for prediction of Preeclampsia

Background: The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus. Aims and Objective: This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies. Materials and Methods: In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done. Results: Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI>1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%). Conclusion: The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.

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Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180184 ◽

2018 ◽

Vol 7 (2) ◽

pp. 628

Author(s):

Rashmi L. ◽

Ashish Bhattacharjee

Keyword(s):

High Risk ◽

Neonatal Intensive Care ◽

Umbilical Artery ◽

Fetal Outcome ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Average Birth Weight ◽

Risk Pregnancy ◽

Umbilical Artery Doppler ◽

Doppler Indices

Background: Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy. The aim of this study was to study the umbilical artery Doppler velocimetry in predicting the fetal outcome in high risk pregnancy. This is a prospective study done over a period of 1 year in Silchar Medical College and Hospital from 1st September 2011 to 31st August 2012. 100 women with singleton pregnancy with high risk admitted in SMCH were subjected to umbilical artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria.Methods: 100 women with high risk pregnancy were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n = 79; 79%), the low-end diastolic flow group (n = 19; 19%) and the group with absent/reversed diastolic flow (n = 2; 2%).Results: Mothers with abnormal velocimetry had more number of caesarean sections than those with normal velocimetry. The diagnosis to delivery interval, gestational age at delivery and average birth weight were comparatively lower with higher incidence of admission to neonatal intensive care unit in foetuses with abnormal umbilical Doppler velocimetry. Sensitivity, specificity, positive and negative predictive values of Doppler for detecting abnormal fetal outcome were 43%, 83%, 33% and 88% respectively. Statistical analysis used: sensitivity, specificity and predictive values.Conclusions: Fetuses with normal flow velocimetry are at lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower than that of neonates with normal velocimetry. Doppler velocimetry studies of umbilical artery can provide the obstetrician important information regarding fetal wellbeing to help him improve fetal outcome.

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Role of uterine and umbilical artery doppler assessment of the uteroplacental circulation in predicting pre-eclampsia: comparison between different doppler parameters

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174134 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4314

Author(s):

Vimla Dhakar ◽

Sabiha Naz

Keyword(s):

High Risk ◽

Uterine Artery ◽

Umbilical Artery ◽

High Sensitivity ◽

High Risk Pregnancy ◽

Trophoblast Invasion ◽

Uterine Artery Doppler ◽

Risk Pregnancy ◽

Doppler Study ◽

Umbilical Artery Doppler

Background: Hypertensive disorders are the common cause of maternal death which affecting nearly 5-10% of pregnancies all over the world. Pre-eclampsia develop from inadequate trophoblast invasion of the maternal spiral arteries and Doppler values permits non-invasive evaluation of uteroplacental circulation and is of great importance in the management of high risk pregnancies. The aim of the study was to assess the findings of Doppler data in predicting pre-eclampsia and comparison of the efficacy of uterine artery Doppler and umbilical artery Doppler.Methods: The study comprises of 100 women with high risk pregnancy attending antenatal clinic at Geetanjali Medical College and Hospital, Udaipur were subjected to uterine and umbilical artery Doppler Study. Women with high risk pregnancy between 26-32 weeks of gestation were studied with colour Doppler. This was a prospective study over a period of 1 year from 2015-2016.Results: The results of the study revealed that 5 out of 100 participants developed pre-eclampsia. Out of different parameters, notch is the best predictor of pre-eclampsia with high sensitivity and highest PPV for uterine artery Doppler and S/D ratio is considered to be best indicator for umbilical artery Doppler. Regarding efficacy, umbilical artery Doppler is more predictive than uterine Doppler.Conclusions: Doppler study can be used for the prediction of pre-eclampsia to reduce maternal morbidity and mortality.

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Value of Third Trimester Uterine Artery Doppler in High-risk Pregnancies for Prediction of Adverse Perinatal Outcome

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1056 ◽

2010 ◽

Vol 2 (1) ◽

pp. 31-35 ◽

Cited By ~ 3

Author(s):

Lavanya Rai ◽

S Lekshmi

Keyword(s):

High Risk ◽

Gestational Age ◽

Perinatal Outcome ◽

Uterine Artery ◽

Umbilical Artery ◽

Perinatal Morbidity ◽

Third Trimester ◽

Uterine Artery Doppler ◽

Adverse Perinatal Outcome ◽

Umbilical Artery Doppler

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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Role of second trimester uterine artery doppler for the prediction of preeclampsia in high risk pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190855 ◽

2019 ◽

Vol 8 (3) ◽

pp. 906

Author(s):

Madhuri Thakur ◽

Reeti Mehra

Keyword(s):

Risk Factors ◽

High Risk ◽

Uterine Artery ◽

High Risk Pregnancy ◽

Second Trimester ◽

Uterine Artery Doppler ◽

Risk Pregnancy ◽

Doppler Study ◽

Doppler Indices

Background: The uterine artery Doppler has potentials for screening for complications of impaired placentation. The purpose of study was to assess the role of uterine artery color Doppler waveform analysis in second trimester for the prediction of preeclampsia in a high-risk pregnancy between 18-24 weeks of gestation.Methods: 100 women with moderate or high-risk factors for developing preeclampsia reporting to Obstetrics and Gynaecology department of Government Medical College and Hospital, Sector 32, Chandigarh were enrolled for present study. Transabdominal uterine artery doppler measurements was done at 18-24weeks of gestation in these patients. Doppler . The Doppler indices generated automatically from the machine , the Pulsatility Index (PI), Resistance Index (RI) , presence or absence of diastolic notch and S/D Ratio were recorded, and average was calculated.Results: Out of 100 patients there were 46 primigravidas with no additional risk factors, 22 pateints with two or more risk factors and there were no patients who had three or more risk factors in present study population. Preeclampsia is seen more commonly in primigravida and primigravida is considered as moderate risk factor for preeclampsia. It was found that an elevated second trimester uterine artery RI was significantly associated with developing preeclampsia later in pregnancy. The sensitivity and specificity of uterine artery Doppler velocimetry were found to be 84% and 55% respectively. Receiver operator characteristics (ROC) curves were created to demonstrate the prognostic value of RI and PI of uterine artery doppler indices at 18-24 weeks of gestation for the development preeclampsia. In addition, there were statistically significant positive correlations between mean RI of uterine artery doppler study and patients who developed preeclampsia. With a sensitivity of 84.21% it could identify 31% of the cases of preeclampsia at a false positive rate of 44.4%.Conclusions: Uterine artery doppler study can be used as a predictor of moderate strength for preeclampsia.

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P77The usefulness of uterine artery Doppler velocimetry in the prediction of high risk pregnancy. I. Normal ranges

Ultrasound in Obstetrics and Gynecology ◽

10.1046/j.1469-0705.2000.00004-1-76.x ◽

2000 ◽

Vol 16 ◽

pp. 83-83

Author(s):

P. Sieroszewski ◽

J. Suzin ◽

G. Surkont ◽

A. Karowicz-Bilińska

Keyword(s):

High Risk ◽

Uterine Artery ◽

High Risk Pregnancy ◽

Doppler Velocimetry ◽

Uterine Artery Doppler ◽

Normal Ranges ◽

Risk Pregnancy

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The Role of Uterine and Umbilical Arterial Doppler in High-risk Pregnancy: A Prospective Observational Study from India

Clinical Medicine Insights Reproductive Health ◽

10.4137/cmrh.s24048 ◽

2015 ◽

Vol 9 ◽

pp. CMRH.S24048 ◽

Cited By ~ 9

Author(s):

Teena Nagar ◽

Deepak Sharma ◽

Mukesh Choudhary ◽

Shusheela Khoiwal ◽

Rajendra Prasad Nagar ◽

...

Keyword(s):

High Risk ◽

Positive Predictive Value ◽

Predictive Value ◽

Uterine Artery ◽

Umbilical Artery ◽

Doppler Imaging ◽

Predictive Values ◽

Umbilical Artery Doppler ◽

Doppler Indices

Aim To study the role of Doppler imaging in prediction of high-risk pregnancies and their outcomes. Methods and Material This prospective study in a setup of tertiary-level care center includes 500 high-risk pregnant women from rural and urban sectors and evaluates the predictive values of various Doppler indices. Results Out of 500 patients, 110 patients had abnormal Doppler among them, 70 patients had abnormal uterine artery Doppler, and 50 patients had abnormal umbilical artery Doppler flow indices. In all, 10 patients had both umbilical artery and uterine artery abnormal Doppler indices. When uterine artery was abnormal (70 patients), 20 patients had preeclampsia, 10 patients had pregnancy-induced hypertension (PIH), and 25 patients had intrauterine growth restriction (IUGR). Systolic/diastolic (S/D) ratio and notch had sensitivity of 60% and positive predictive value of 33.3% and 37.5%, respectively. When umbilical artery was abnormal (50 patients), 10 had preeclampsia, 15 had PIH, and 15 had IUGR. S/D ratio had the highest positive predictive value of 40%; sensitivity is same for all. In uterine artery, combination of parameters had the best sensitivity of 80%, followed by notch and S/D ratio. In umbilical artery, combination of parameters, S/D ratio, and RI (resistance index) had sensitivity of 40%; specificity of all the indices was 91-96%. In all, 20 patients had bilateral notch, and among them 15 developed preeclampsia and 15 developed IUGR. When both uterine and umbilical artery Doppler were abnormal (10 patients), all patients had preeclampsia and IUGR. Conclusion Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

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