DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20163411
Published: 2016-12-15

Role of Doppler indices in prediction of perinatal outcome in preeclampsia

Swapnali C. Kshirsagar, Sneha S. Shirodkar, Sunil J. Yadav, Umesh M. Zile

Abstract


Background: Preeclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide, particularly in developing countries. The objective of the study was to study Doppler indices in pregnancies with preeclampsia and to correlate Doppler indices with perinatal outcome.

Methods: This was a prospective study conducted within a period of September 2012 to August 2014 where 100 singleton preeclampsia patients attending tertiary care hospital were recruited. These patients were followed by serial Doppler assessment and the result of the last Doppler examination within 10 days of delivery was considered in the subsequent correlation with perinatal outcomes. Perinatal outcome was studied under major and minor adverse outcome.

Results: In this study out of total population 54% were primigravida patients. 43.75% caesarean sections done for fetal distress with abnormal Doppler. Bilateral uterine artery diastolic notch and umbilical artery S/D ratio have better sensitivity (72.55%) for prediction of minor adverse outcome while uterine artery diastolic notch has better sensitivity (86.67%) for major adverse outcome. Umbilical artery and middle cerebral artery RI have better specificity and positive predictive value  for prediction of both major and minor adverse outcome. Bilateral uterine artery notch and umbilical artery S/D ratio have better negative predictive value for prediction of both major and minor adverse outcome.

Conclusions: In this study it is concluded that Doppler analysis helps not only earlier detection of uteroplacental and fetoplacental changes associated with the disease but also help to take decision for early intervention. Doppler technology has provided the best opportunity for repetitive non-invasive haemodynamic monitoring in pregnancy for fetal well-being evaluation and predicting perinatal outcome.


Keywords


Preeclampsia, Doppler, Perinatal outcome

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References


Villar J, Say L, Gulmezoglu M. Eclampsia and preeclampsia: a worldwide health problem for 2000 years. In :Critchley, Mac Lean A , Poston L , Walker J(Eds). Preeclampsia. Landon: RCOG Press. 2003;189-207.

Khalid M, Wahab S, Kumar V, Khalid S, Haroon S, Noor A. Sabzposh Doppler indices in prediction of fetal outcome in hypertensive pregnant women. Nepal Journal of Obstetrics and Gynaecology. 2011;6(1):28-34.

Roberts JM, Cooper DW. Pathogenesis and Genetics of preeclampsia (review). Lancet. 2001;357:53-6.

Bano S, Chaudhary V, Pandey S, Mehta UL, Sharma AK. Color Doppler evaluation of cerebral umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. 2010;20(1):20-5.

Fleischer, Ruth B, Goldstein. Collen ultrasonography in obstetrics and gynecology; 2010:53-54.

Maler J, Manor D, Itskovitz J. Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol. 1990;162:121-5.

Maulik D, Yarlagadda P, Downing G. Doppler velocimetry in obstetrics. Obstet Gynecol Clin North Am. 1990;17:63-86.

Park YW, Choe JS, Kim HS, Kim JS. The clinical implication of early diastolic notch in third trimester Doppler analysis of uterine artery J. Ultrasound Med. 1996;15:47-51.

Fichera A, Pagani G, Gerosa V, Gregorini M, Rovida P, Prefumo F, et al. The role of uterine artery pulsatility index for prediction of outcome in pregnancies complicated by pre-eclampsia. Ultrasound in Obstet Gynae. 2012;40(1):171-310.

Asselt KV, Gudmundsson S, Lindqvist P, Marsal K. Uterine and umbilical artery velocimetry in pre-eclampsia. 1998;77(6):614-5.

Schulman H, Gleischer A, Stern W. Umbilical wave ratios in human pregnancy. Am J Obstet Gynecol. 1984;148:985-90.

Kofinas AD, Penry M, Nelson LH, Meis PJ, Swain M, Salem W. Uterine and umbilical artery flow velocity waveform analysis in pregnancies complicated by chronic hypertension or preeclampsia. Southern Medical Journal. 1990;83:2.

Borges KJJ, Hassan N, Hussain R, Akhtar MT. Effects of variation in umbilical artery resistive index on placental morphology and birth weight in pregnancy induced hypertension. J Ayub Med Coll Abbottabad. 2013;25(3):23-6.

Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging. 2006;16:109-16.