Published: 2016-12-15

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Smriti Agrawal, Vinita Das, Anjoo Agarwal, Amita Pandey


Background: To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.

Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualized and cerebroumblical PI ratio calculated. MCA-RI<2SD was taken as abnormal. Adverse perinatal outcome was taken as major if there was stillbirth, immediate neonatal death, need of respiratory support and minor if neonatal nursery admission was done. Presence of acute fetal distress in labour was also noted.

Results: There were 107 women in the study. Major adverse outcomes were 11. Umbilical artery-S/D ratio>2SD (RR 4.46, 95% CI 1.40-14.17) and RI>2SD (RR 3.36, 95% CI 1.03-10.61) and MCA RI<2SD (RR 4.46, 95% CI1.4-14.17) had a high relative risk to predict adverse major perinatal outcome. 39 babies were admitted in neonatal nursery and no parameters could predict them. Though UA-PI>2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.

Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.


Fetal distress, Stillbirths, Hypertension in pregnancy

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Romero R, Kalache KD, Kada N. Timing the delivery of the preterm severely growth restricted fetus: venous Doppler, cardiotocography on the biophysical profile? Ultrasound Obstet Gynacol. 2002;19:118-21.

Giles WB, Trudringer BJ, Baird PJ. Fetal Umbilical flow velocity wave form and placental resistance pathological co-relation. Br J Obstet Gynacol. 1985;92:31-8.

Mendez MA, Gayta MV, Flores R. Doppler ultrasound evaluation in preeclampsia. BMC Res Notes. 2013;19:477.

Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol. 1992;79(3):416-20.

Bano S, Chaudhary V, Pande S, Mehta VC, Sharma AK. Colour Doppler evaluation of cerebral umbilical pubatility ratio and its usefulness in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome. Indian J Radiol Imaging. 2010;20(1):20-5.

Mari G, Hanif F, Kruger M, Cosmi E, Forgas SJ, Treadwell MC. Middle cerebral artery peak systolic velocity a new Doppler parameter in the assessment of growth restricted fetus. Ultrasound Obstet Gynacol. 2007;29(3):310-6.

Schenone MH, Mari G. The MCA Doppler and its role in the evaluation of fetal anemia and fetal growth restriction. Clin Perinatal. 2011;38(1):83-102.

Hecher K, Campbell S, Doyle P, Harrington K, Nicoladies K. Asessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation. Circulation. 1995;91:129-38.

Baschat AA, Gembruch U, Weiner CP, Harman CR. Qualitative venous Doppler waveforms analysis improves prediction of critical perinatal outcome in premature growth restricted foetuses. Ultrasound Obstet Gynacol. 2003;22:240-5.

Brown MA, Lindheimer MD, Swiet M, Assche VA, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the international society for the study of hypertension in pregnancy (ISSHP). Hypertens Pregnancy. 2001;20:19-24.

Kurmanavicius J, Florio I, Wisser J, Hebisch G, Zimmermann R, Muller R et al. Refence resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24-42 weeks of gestation. Ultrasound Obstet Gynecol. 1997;10:112-20.

Ozeren M, Dinc H, Ekmen U, Senekayli C, Aydemir V. Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur J Obstet Gynecol Reprod Biol. 1999;82:11-6.

Yoon BH, Lee CM, Kim SW. An abnormal umbilical artery waveform: A strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obs Gyn. 1994;171:713-21.

Lakhar BN, Rajagopal KV, Gourisankar PT. Ind J Radiol Imag. 2006;1:109-16.

Martinez R, Figueras F, Andrade HE, Oros D, Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol. 2011;117(3):618-26.