Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Absence of Wharton's jelly around an umbilical artery

Wharton's jelly is a mucoid, avascular and connective tissue which plays the role of umbilical vessels protection. Its absence exposes to poor neonatal outcomes or fetal death. We report a rare case of Absence of Wharton’s Jelly, diagnosed by examination of the placenta the examination with a live fetus.

Hemodynamical parameters in functional system "motherplacenta-fetus" in women had higher levels of alpha-fetoprotein (AFP) and horionic gonadotropin (HG) in 11 trimester of pregnancy

Haemodinamic parameters in the functional system mother-placenta-fetus in 49 women with elevated mildtrimester maternal serum AFP (2MoM) and in 38 women with elevated maternal serum hCG (2MoM) were studed. The control group included 32 women with normal mildtnmester serum AFP and hCG. Indexes of impedance to flow in the uterine arteries were significantly higher in patients with elevated MSAFP or MShCG comparing with women of the control group, beginning from 28 weeks of pregnancy. There was a significant association between the maternal serum AFP levels and indexes of impedance to flow in the uterine artery, umbilical artery and fetal aorta during pregnancy. In patients with abnormal (more then 95th centile) uterine arteries Resistance Index at 2024 weeks, abnormal dynamic of MSAFP and MShCC levels from 16 until 24 weeks was observed. We suppose that unexplained elevated mildtri mester maternal serum AFP and hCC сaп be associated with disturbed utero-placental circulation.

The Role of The Doppler Study (Umbilical, Middle, Cerebral Arteries and Ductus Venosus) to Predict General Adverse Pregnancy Outcomes in Patients With Hypertensive Diseases in The Third Trimester

Background: The hypertensive pregnancies complicated by preeclampsia show an increase in maternal and perinatal morbidity and mortality.Color Doppler ultrasound has been employed for fetal surveillance. Objective: To evaluate the role of Doppler study in the prediction of adverse pregnancy outcomes in hypertensive pregnant women at the third trimester of pregnancy. Patients and Methods: A clinical prospective follow up study conducted in Outpatient Ultrasound Clinic at Al-Imamein Kadhimein Medical City, Baghdad, Iraq from 1st July, 2018 till 31st of July 2019 included 50 pregnant women with hypertensive disorder of pregnancy at the third trimester. The fetal and neonatal outcome was reported poor when intrauterine fetal death occurs during follow-up of pregnant women or more than two of the reported neonatal complications were poor. Results: Means of the middle cerebral artery and umbilical artery-resistance and pulasatility indices ratio were significantly decreased among pregnant women with poor neonatal outcomes. Similarly, the umbilical artery end-diastolic flow and Ductus Venousu waveforms were Conclusion: The middle cerebral artery and umbilical artery indices of pregnant women with hypertensive disorders are good predictors for neonatal outcomes. Keywords: Hypertensive disorder, Middle cerebral artery, Umbilical artery, Ductus venosus