A prospective study of doppler velocimetry in pregnancy-induced hypertension in a rural population of a developing country

Abstract

Background: Pregnancy-induced hypertension (PIH) remains a great challenge to obstetricians. Doppler velocimetry can detect fetal compromise much before other antepartum tests. Aim: The aim of this study is to detect the changes of uterine artery, umbilical artery and middle cerebral artery in PIH by Doppler velocimetry. Subjects and Methods: This prospective study was conducted on hundred subjects with PIH. Doppler studies were carried, and parameters recorded in uterine, umbilical and middle cerebral artery (MCA) were Systolic/Diastolic ratio, Resistance Index, Cerebro-Placental Index (CPI). Fetal outcomes were monitored. Statistical analysis was performed using Epi Info TM software (Version 3.5.1, CDC, Atlanta). Test for significance was done with student's t-test and Chi-square where applicable. A P-value of<0.05 was considered as significant. Results: Among the 100 subjects, 76 (76%) of fetuses had abnormal and 24% normal umbilical artery Doppler velocimetry; 62% had abnormal and 38% normal MCA Doppler velocimetry; 64% fetuses had abnormal and 36% normal CPI. In 95% of subjects having abnormal umbilical Doppler studies, caesarean section had to be done for acute fetal distress. Incidence of caesarean section was 61% in abnormal MCA group and 63% in abnormal CPI group. Among 14 patients who had abnormal uterine artery Doppler, four developed pre-eclampsia, 2 IUGR. In patients with notches in uterine artery Doppler, 38% developed pre-eclampsia, 38% had IUGR, 13% babies were still born and 25% of newborns required NICU admission. In umbilical artery Doppler, when S/D ratio was abnormal, 60% developed pre-eclampsia, 40% had IUGR and 40% of newborns had to be admitted in NICU. Conclusion: Doppler study for fetal surveillance in pregnancy-induced hypertension is a very useful device and abnormal umbilical artery and uterine artery velocimetry seems to have worse pregnancy outcomes in the present study. Notch as a single parameter is the best indicator with highest sensitivity and positive predicative values. However, combination of parameters is the best indicator.

Giá Trị Của Siêu Âm Doppler Động Mạch Tử Cung Dự Báo Tiền Sản Giật Ở Thai Phụ 14-28 Tuần Tại Bệnh Viện Đa Khoa Hoàn Mỹ Cửu Long

“…Nhưng nhìn chung thì giá trị S/D có giá trị cao trong tiên lượng tiền sản giật. Kết quả nghiên cứu của chúng tôi tương đồng với nghiên cứu của tác giả Havra [11] nghiên cứu đoàn hệ tiến cứu trên 100 thai phụ, kết quả nghiên cứu cho thấy giá trị S/D trên siêu âm Doppler động mạch tử cung tiên lượng tiền sản giật có độ nhạy 60%, độ đặc hiệu 93,7%, giá trị tiên đoán dương 33,3%, giá trị tiên đoán âm 97,3%. Ở nghiên cứu này tác giả cũng loại trừ các trường hợp tăng huyết áp mãn và không có can thiệp điều trị dự phòng tiền sản giật như trong nghiên cứu của chúng tôi.…”

Fetal Umbilical Artery Velocimetry Indices and Pregnancy Outcome Among Preeclamptic Women at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria

“…Worldwide, Preeclampsia complicates about 5-10% of all pregnancies. It is one of the leading causes of maternal and perinatal mortality, fetal growth restriction and prematurity [1][2][3][4][5][6][7][8][9] . According to World Health Organization (WHO), Preeclampsia is about seven times higher in developing countries [10] .…”

“…Identifying at-risk fetuses in developing countries where the perinatal mortality rate is about 14 times higher than in developed countries is vital to improving perinatal outcomes [5] . Some studies have found that haemodynamic indices of the fetal umbilical artery (UmA) and Middle cerebral artery (MCA) may detect fetal compromise much before any other antepartum test [6,7] .…”