Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting

Abstract

Background Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). Methods A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured. Results All UA indices were significantly higher in the case group compared to the controls (p < 0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p < 0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79, 72.8 and 73.3%, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52, 87 and 57%, respectively. Conclusion In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.

A new Doppler index, cerebro‐placental‐uterine ratio, and fetal cardiac parameters in early onset preeclampsia

“…[18][19][20][21] In their study, Moawad et al compared various fetal Doppler parameters in late-onset preeclampsia with severe features and found that UA Doppler is still an effective method for unfavorable birth outcomes and disease management. 22 Our study has some limitations. Although our study emphasizes the importance of CPUR in preeclampsia, more comprehensive results will be obtained with larger series and prospective studies that include neonatal blood gas parameters.…”

“…Uterine artery Doppler, umbilical artery Doppler and middle cerebral artery Doppler, and cerebroplacental ratio have been studied exclusively to predict disease severity and unfavorable perinatal outcome in conditions associated with placental insufficiency 18–21 . In their study, Moawad et al compared various fetal Doppler parameters in late‐onset preeclampsia with severe features and found that UA Doppler is still an effective method for unfavorable birth outcomes and disease management 22 . However, of the individual parameters, only the CPR index was found to be the best index for predicting such outcomes.…”

“…As a result of vascular and fetal cardiac adaptation, fetal blood redistribution is associated with a low cerebroplacental ratio (CPR; middle cerebral artery PI /UA–PI), reflecting the protective effect on the brain. Studies have shown that CPR is an effective means of detecting at‐risk fetuses, including stillbirths, at birth 18–22 . The cerebroplacental uterine ratio (CPUR) is a new combination of Doppler variables and has emerged as a new marker of placental insufficiency 23–25 .…”

“…Studies have shown that CPR is an effective means of detecting at-risk fetuses, including stillbirths, at birth. [18][19][20][21][22] The cerebroplacental uterine ratio (CPUR) is a new combination of Doppler variables and has emerged as a new marker of placental insufficiency. [23][24][25] The CPUR is calculated as the ratio between the cerebro-placental ratio and the uterine artery pulsatility index using the formula CPR/UtA-PI.…”

Outcome of neonates born to mothers with pregnancy induced hypertension/preeclampsia: a systematic review

“…11 Moawad et al found that fetal doppler parameters are associated with late onset (>34 weeks) preeclampsia and determined poor neonatal outcomes. 12 Piotr et al studied the link between angiogenesis markers in maternal blood including anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) and pro-angiogenic factor, placental growth factor (PlGF) and its impact on neonatal outcomes. [13][14][15] It was found that a high sFlt-1/PlGF before 32 weeks GA was associated with significant increase in adverse neonatal outcomes including respiratory distress syndrome, patent ductus arteriosus, sepsis, intreventricular hemorrhage, retinopathy of prematurity and bronchopulmonary dysplasia.…”