Uterine artery Doppler screening as a predictor of pre-eclampsia

Hypertensive disorders represent the second most common cause of maternal death, affecting 5–10% of pregnancies worldwide and accounting for 19% of maternal deaths in South Africa. Pre-eclampsia is believed to develop from inadequate trophoblast invasion of the maternal spiral arteries. Doppler imaging permits non-invasive evaluation of the uteroplacental circulation and is invaluable in the management of high risk pregnancies.A prospective quantitative experimental study tested the hypothesis that uterine artery (UA) spectral Doppler screening is able to identify patients at risk for developing preeclampsia. Convenience sampling allowed for the recruitment of 144 patients (11–14 weeks gestation) who attended the antenatal clinic at Rahima Moosa Mother and Child Hospital between November 2008 and July 2010. A complete record of 121 participants was available for the final analysis.The results of this study revealed that 7 (5.8%) participants developed pre-eclampsia. Race was identified as the most significant independent variable with an odds ratio of 1.5; 26 and 9 to 1 for developing PET in the 1st, 2nd and 3rd trimesters respectively.Uterine Artery Doppler is promising. An ultrasound screening programme in high risk pregnant women would offer clinicians the opportunity to pre-empt the disease before it manifests clinically.

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

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.38390 ◽

2021 ◽

Vol 12 (10) ◽

pp. 135-141

Author(s):

Rohini Singh ◽

Sudipa Mondal ◽

Manisha Bajaj ◽

Debasmita Mandal

Keyword(s):

High Risk ◽

Uterine Artery ◽

Umbilical Artery ◽

Doppler Velocimetry ◽

Third Trimester ◽

Uterine Artery Doppler ◽

Risk Pregnancy ◽

Patients At Risk ◽

Umbilical Artery Doppler ◽

Doppler Indices

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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Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial

Advances in Preventive Medicine ◽

10.1155/2015/373041 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Abbas Rakhshani ◽

Raghuram Nagarathna ◽

Rita Mhaskar ◽

Arun Mhaskar ◽

Annamma Thomas ◽

...

Keyword(s):

High Risk ◽

Standard Care ◽

Uterine Artery ◽

Controlled Trial ◽

Resistance Index ◽

High Risk Pregnancy ◽

Trophoblast Invasion ◽

Control Group ◽

Risk Pregnancy ◽

Yoga Group

Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues.Methods. 59 high-risk pregnant women were randomized into yoga (n= 27) and control (n= 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation.Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P= 0.001), head circumference (P= 0.002), femur length (P= 0.005), and estimated fetal weight (P= 0.019). The resistance index in the right uterine artery (P= 0.01), umbilical artery (P= 0.011), and fetal middle cerebral artery (P= 0.048) showed significantly lower impedance in the yoga group.Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation.

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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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Five years’ experience in an anesthesiology antenatal clinic for high-risk patients

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0016 ◽

2018 ◽

Vol 46 (3) ◽

pp. 287-291 ◽

Cited By ~ 2

Author(s):

Daniel Shatalin ◽

Yaacov Gozal ◽

Sorina Grisaru-Granovsky ◽

Alexander Ioscovich

Keyword(s):

High Risk ◽

Cesarean Section ◽

Mode Of Delivery ◽

Antenatal Clinic ◽

Management Plan ◽

Elective Cesarean Section ◽

Nulliparous Women ◽

Mother And Child ◽

Elective Cesarean ◽

Hospital Births

Abstract Introduction: The aim, of this study is to describe our approach and outcomes in an outpatient anesthesia/analgesia antepartum clinic among ambulatory high-risk obstetric patients. Methods: This was a retrospective evaluation of the activity of the anesthesiology antenatal clinic from its inception in 2010 until 2016 (a 5-year period). The clinic works in collaboration with the Department of Obstetrics and Gynecology. The catchment area of the study University Affiliated Hospital attends a multiethnic population characterized by high parity. Results: There were 241 referrals over the 5 years, each of whom was discharged with a consult and a delivery management plan and 228 (95%) of which were performed as planned. Mean gestational age at consultation was 34.4 weeks (range: 20–37). There were no preconceptional consultation. No limitations regarding mode of anesthesia/analgesia was considered for 47% of the referrals. Nulliparous women accounted for 50% of the referrals and 17% were in their second pregnancy. The greatest number of referrals (30%) was for musculoskeletal conditions. No maternal death encountered. The mode of delivery was vaginal in 139 (65%) women; elective cesarean section in 44 (21%) women; and emergent cesarean section in 30 (14%) women. The neonatal outcomes were unremarkable; 210 (87%) in hospital births, 97.1% had an a 5′ Apgar score of 9. Conclusion: Our findings reveal the need for high-risk obstetric patients consult with a dedicated obstetric anesthesiologist to devise a management plan for labor and delivery that is tailored to their comorbidity and obstetric status, to ensure an optimum outcome for mother and child.

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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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