Study of Doppler waveforms in pregnancy induced hypertension and its correlation with perinatal outcome

Authors

  • Smitha K Department of Obstetrics and Gynaecology, Kempegowda Institute of Medical Sciences, V.V. Puram, Bangalore, Karnataka, India
  • Sowmya K Department of Obstetrics and Gynaecology, Kempegowda Institute of Medical Sciences, V.V. Puram, Bangalore, Karnataka, India
  • Malathi T Department of Obstetrics and Gynaecology, Kempegowda Institute of Medical Sciences, V.V. Puram, Bangalore, Karnataka, India

Keywords:

Umbilical artery Doppler, Middle cerebral artery Doppler, Cerebroplacental ratio, IUGR, Absent end diastolic flow, Reversed end diastolic flow, Perinatal outcome

Abstract

Background: Objectives of current study were to study the significance of Doppler in PIH using middle cerebral artery and umbilical artery blood flow and to analyze the role of Doppler in PIH in predicting perinatal outcome.

Methods: Hundred cases of women with pregnancy induced hypertension between 28-40 weeks of gestation were studied for umbilical artery and middle cerebral artery Doppler waveforms. The perinatal outcome results were documented and analyzed statistically using percentage and Chi-square test.

Results: Adverse perinatal outcome was significantly associated with oligohydramnios (P <0.0001) and grade 3 placental maturity (P <0.01). Absent end diastolic flow waveform in umbilical artery was associated with mortality of 27.78% and reverse end diastolic waveform with mortality of 100%.  UA PI has the highest sensitivity (88.88%) and positive predictive value (69.56%) in predicting low birth weight. Cerebroplacental ratio (MCA/UA) had highest sensitivity (94.42%), PPV (86.42%), accuracy (90%) for predicting adverse perinatal outcome than UAPI and MCA PI. MCA PI had low specificity in predicting adverse perinatal outcome.

Conclusions: Pregnancy induced hypertension is associated with significant fetal morbidity and mortality. Oligohydramnios in PIH patients is associated with adverse pregnancy outcome. Presence of absent end diastolic flow and reversed end diastolic flow in umbilical artery is an ominous sign with high perinatal mortality. Reversed end diastolic flow is more ominous than absent end diastolic flow. Cerebroplacental ratio (MCA/UA PI) is a better predictor of adverse perinatal outcome, with highest diagnostic accuracy, sensitivity, and positive predictive value, than either vessel Doppler indices considered alone. Colour Doppler study is a simple, quick, non-invasive procedure and is found to be the most accurate among the other tests for antepartum fetal surveillance.

References

Carroll BA. Duplex Doppler systems in obstetric ultrasound. Radiol Clin N Am. 1990 Jan; 25(1):189-202.

Divon MY, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynaecol. 1992;45(4):1015-25.

Alferevic Z, Neilson JP. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;(2):CD000073.

Harrington K, Carpenter RG, Nguyen M et al. Changes observed in Doppler studies of the fetal circulation in pregnancies complicated by preeclampsia or the delivery of a small for gestational age baby. I cross sectional analysis. Ultrasound Obstet Gynaecol. 1995;6(1):19-28.

Arduini D, Rizzo G. Prediction of fetal outcome in small for gestational age fetus; comparison of Doppler measurements obtained from different fetal vessels. J Perinat Med. 1992;20(1):29-38.

Gramellini D, folic MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ration as a predictor of adverse perinatal outcome. Obstet Gynaecol. 1992;79:416-20.

Berkowitz GS, Mehalek KE, Chitkara U et al. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynaecol. 1988;71:742-6.

Fairlie FM, More HM, Walker JJ et al. Determinants of perinatal outcome in pregnancy induced hypertension with absence of umbilical artery end diastolic frequencies. Am J Obstet Gynaecol. 1991;164:1084-9.

Wladimiroff JW, Wijngaard JAGW, Degani S, Noordam MJ, Eyck J, Tong HM. Cerebral umbilical artery blood flow velocity wave forms in normal and growth retarded pregnancies. Obstet Gynaecol. 1987;69:705-9.

Arbeille PH, Trauquant F, Body G et al. Evolution de la circulation arterielle ombilicale et cerebrale du fetus au cours de la grossesse. In: Arbeille PH, Trauquant F, Body G, eds. Progres en Neonatologie. 1st ed. Basel: Karger Editions; 1996: 30-37.

M. Venkataswamy Reddy. Statistics for mental health care research. In: M. Venkataswamy Reddy, eds. NIMHANS. India: NIMHANS Publication; 2002.

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

Schulman H. Doppler velocimetry of the umbilical and uteroplacental circulation: a critical review. Echocardiogr. 1990;7:583-7.

Ozeren M, Dinc H, Ekmen U, Senakayli C, Aydemir V. Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur J Obstet Gynaecol Reprod Biol. 1999;82(1):11-6.

Fong KW, Ohlsson A, Hannah ME, Grisaru S, Kingdom J, Ryan M et al. Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiol. 1999;213:681-9.

Gutierrez RG, Barajas AI, Curiel CA, Ponce de Leon PAL. Prediction of fetal wellbeing with Doppler flowmetric profile in pregnant hypertensive women. Gynaecol Obstet Mex. 2001;69:460-6.

Mandruzzato GP, Bogatti P, Fischer L, Gigli C. The clinical significance of absent or reverse end diastolic flow in the fetal aorta and umbilical artery. Ultrasound Obstet Gynaecol.1991;1(3):192-6.

Eronen M, Kari A, Pesonen E, Kaaja R, Wallgren EI, Hallman N. Value of absent or retrograde end diastolic flow in fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy induced hypertension. Acta Paediatr. 1993;82(11):919-24.

Karsdorp VH, van Vugt JM, van Geijn HP, Kostense PJ, Arduini D, Montenegro N, Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Lancet. 1994 Dec;344(8938):1664-8.

Chauhan SP, Reynolds D, Cole J, Scardo JA, Magann F, Wax J, Morrison JC. Absent or reversed end diastolic flow in the umbilical artery; outcome at a community hospital. J Miss State Med Assoc. 2005;46(6):163-8.

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Published

2017-01-02

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Original Research Articles