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

2015 ◽  
Vol 9 ◽  
pp. CMRH.S24048 ◽  
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.

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

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.

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

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.

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

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.

scholarly journals Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

2020 ◽  
Vol 9 (10) ◽  
pp. 4130
Author(s):  
Lakshmi Manjeera M. ◽  
Patricia Malini Pereira
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
Resistance Index ◽  
Early Screening ◽  
Predictive Values ◽  
Uterine Artery Doppler ◽  
Doppler Study

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.

scholarly journals Early Uterine and Umbilical Artery Doppler Indices as Predictor for Preeclampsia and Intrauterine Growth Restriction

2021 ◽  
pp. 116-126
Author(s):  
Sara E. Khalil ◽  
Mohammed M. Elnamory ◽  
Mona K. omar ◽  
Hesham M. Eltokhy
Keyword(s):  
Gestational Age ◽  
Predictive Value ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Doppler Study ◽  
Significant Difference ◽  
Umbilical Artery Doppler ◽  
Doppler Indices

Background: Preeclampsia (PE) is a disorder that causes hypertension and proteinuria after week 20 of pregnancy. Several Uterine Artery (UtAs) Doppler characteristics have been investigated for their ability to predict PE. The purpose of this research is to look into the uterine and umbilical arterial Doppler indices in the early second trimester for the prediction of late preeclampsia or intrauterine growth restriction. Methods: This is a prospective cohort clinical study and was done at Obstetrics and Gynecology department, faculty of medicine Tanta university hospital from January 2020 till April 2021. 150 pregnant women aged from 18 to 30 years old with gestational age from 13 to 16 weeks of pregnancy. Study was done by the same observer by machine MINDRAY DC60 Measurement of fetal biometry (BPD, FL, AC, HC) Gestational age was confirmed with Detection of congenital malformation.    Results: There is a significant difference between the groups regarding uterine and umbilical artery doppler Indices. Uterine RI only yielded significance for predicting IUGR with sensitivity of 62% and specificity of 88%, with Positive predictive value (PPV) 37% and Negative predictive value (NPV) 92%. Umbilical resistance index achieved sensitivity of 56% and specificity of 82%, with PPV 31% and NPV 30% with on statistical significance. Conclusions: Combination of uterine and umbilical artery Doppler study in early pregnancy is one of the best indicator for prediction of preeclampsia and IUGR. Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

Basic variables at different positivity thresholds of a quantitative immunochemical test for faecal occult blood

2002 ◽  
Vol 9 (3) ◽  
pp. 99-103 ◽  
Author(s):  
G. Castiglione ◽  
G. Grazzini ◽  
G. Miccinesi ◽  
T. Rubeca ◽  
C. Sani ◽  
...  
Keyword(s):  
High Risk ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Occult Blood ◽  
Recall Rate ◽  
Population Based ◽  
Detection Rates ◽  
Predictive Values ◽  
Faecal Occult Blood ◽  
Faecal Occult

OBJECTIVES: Screening by faecal occult blood testing (FOBT) is effective in decreasing mortality and incidence of colorectal cancer (CRC). Immunochemical tests have proved to be more cost effective than guaiac FOBTs. The latex agglutination test (LAT) has the advantage of being a fully automated, quantitative test. The aim of this study is to interpret the overall experience with LAT according to different positivity thresholds. SETTING: A population based screening programme is currently running involving subjects aged 50–70, invited every 2 years to have an FOBT. LAT is the standard screening test and has a positivity threshold for further diagnostic tests of 100 ng haemoglobin/ml of sample solution. METHODS: Positivity rates, detection rates for CRC high risk adenomas, and positive predictive values for CRC, high risk adenomas, and low risk adenomas were calculated for several positivity thresholds. RESULTS: 19 132 attendances at screening were recorded (11 774 at first screening, 7358 at subsequent screenings). Progressively increasing the positivity threshold from 100 to 200 ng/ml showed (a) a decrease in positivity rate; (b) a decrease in detection rates for CRC or high risk adenomas; (c) an increase in positive predictive values for cancer; (d) an increase in positive predictive value for high risk adenomas. CONCLUSIONS: Increasing the positivity threshold of the LAT reduces recall rate and improves positive predictive value for cancer or high risk adenomas but substantially decreases the detection rate of CRC and high risk adenomas. For this reason increasing the positivity cut off for LATs is not advisable. On the other hand decreasing the positivity threshold would increase recall rate and sensitivity of screening. Careful evaluation of sensitivity of the quantitative results of the LAT for interval cancers is needed to definitively assess the optimal positivity threshold for LATs in population based screening programmes.

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

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. 

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

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.

scholarly journals DOPPLER STUDY OF THE UTERINE AND UMBILICALARTERY TO PREDICT INTRAUTERINE GROWTH RETARDATION

2020 ◽  
pp. 8-10
Author(s):  
Rabiya Baseri Nelofar ◽  
Sushma Vuyyuru ◽  
Sri Hari Raavi ◽  
Nandam Hema Mohana Lakshmi
Keyword(s):  
Predictive Value ◽  
Intrauterine Growth Restriction ◽  
Uterine Artery ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Indirect Evidence ◽  
Growth Restriction ◽  
Doppler Imaging ◽  
Intrauterine Growth ◽  
Doppler Study

The primary objective of this study is to transvalue the role of colour doppler sonography in the evaluation of pregnancy with intrauterine growth restriction. The study included 50 antenatal women with singleton pregnancy diagnosed as having a fetus with intrauterine growth restriction based on greyscale ultrasound findings. Further, an obstetric Doppler Ultrasound was done, and diagnostic statistics were applied to determine the Umbilical artery PI, RI, and Uterine artery PI, RI and correlating with perinatal outcomes. The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for all Doppler measurements. Among women with an identifiable cause, 42% had pregnancy-induced hypertension (PIH), 40% had moderate to severe anaemia complicating pregnancy. At the same time, 20% of the study group had no detectable cause for IUGR. The persistence of early diastolic notch beyond 26 weeks showed 60% sensitivity as a predictor for the perinatal outcome. The sensitivity of RI, PI of the uterine artery in predicting perinatal outcomes was 73 % and 76.7 %, respectively. Whereas, the sensitivity of RI, PI of the Umbilical artery in predicting perinatal outcomes was 63% and 70%, respectively. Doppler imaging provides indirect evidence of fetal compromise and is known to improve outcomes of high-risk pregnancies with intrauterine growth restriction. Hence, it is of eminent value for monitoring during the pregnancy.

scholarly journals Study of abnormal umbilical artery doppler and neonatal outcome

2019 ◽  
Vol 10 (5) ◽  
pp. 98-101
Author(s):  
Gyawali Merina ◽  
Poudel Ramesh
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Predictive Value ◽  
Umbilical Artery ◽  
Neonatal Outcome ◽  
Perinatal Asphyxia ◽  
Appropriate For Gestational Age ◽  
Umbilical Artery Doppler

Background: Doppler provides assessment of uteroplacental and fetoplacental circulation during pregnancy. It is a sensitive tool in early detection of fetal compromise and allows needful intervention. Aims and Objective: To study the role of umbilical artery doppler in clinically suspected IUGR and its implication on neonatal outcome. Materials and Methods: A total of 104 singleton pregnancies with gestational age of more than 34 weeks who had clinical suspicion of IUGR were evaluated using obstetric ultrasound and doppler. Umbilical arteryvelocimetry with S/D >3 and RI >0.7 were considered abnormal. Newborns were classified as either small for gestational age (SGA) ie, IUGR or appropriate for gestational age (AGA). Neonatal outcome were classified as either normal or adverse events that included still birth, NICU admissions, perinatal asphyxia and/or neonatal death. Results: Out of 104 clinically suspected IUGR, 55 were born with small for gestational age. Among these SGA neonates, 45 subjects had abnormal umbilical artery S/D and 42 had abnormal RI. Abnormal umbilicalartery S/D ratio had a sensitivity of 81.8 %, specificity of 59.2 %, the positive predictive value of 69.2 % and negative predictive value of 74.4 %. Abnormal Umbilical artery RI had a sensitivity of 76.4 %, specificity of 69.4 %, positive predictive value of 73.7 % and negative predictive value of 72.3 % in diagnosing IUGR. Abnormal umbilical artery velocimetry was associated with increased morbidity and mortality in IUGR neonates. Conclusions: Umbilical artery doppler plays an important role in diagnosing IUGR and predicting neonatal outcome.

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