Factors Affecting Morbidity and Mortality in Acute Pancreatitis

Abstract

Prediction of risk is the cornerstone of antenatal care. Early prenatal diagnosis of FGR aids in decision making concerning the timing and the route of delivery thereby reducing the perinatal risk. Circulatory changes, reflected in certain fetal Doppler waveforms, predict adverse perinatal outcome. The present work aimed to study the waveforms and color flow of umbilical artery, uterine artery and middle cerebral artery and accuracy of Color Doppler in predicting FGR. Material and Methods: A total of 100 clinically suspected FGR subjects were enrolled for the purpose of this study Ultrasound examination by Color Doppler carried out serially every three weeks starting from 30 weeks till delivery on Color Doppler machine Chi-square test and Independent Samples t-test was used for statistical analysis. Receiver-Operator curve analysis was performed to find out appropriate cutoff points for prediction of FGR. Results: For color Doppler, the uterine artery RI was found to be most efficient from the point of view of early detection, it had a sensitivity of 84.6%, specificity of 82.9% and diagnostic accuracy of 84% even at 30 week interval. Uterine artery PI was found to be 76.9% sensitive, 82.9% specific and had 79% diagnostic accuracy at 30 weeks. Umbilical artery RI was found to be 80% sensitive, 74.3% specific and had a diagnostic accuracy of 78% at 30 weeks whereas Umbilical artery SD ratio was 70.8% sensitive and 65.7% specific and had a diagnostic accuracy of 69% at 33 weeks interval. MCA RI had only 60% sensitivity and 71.4% specificity at 36 weeks interval whereas MCA PI had 66.2% sensitivity and 68.6% specificity at 36 weeks interval. MCA PSV was not found to be a useful tool as it did not produce a significant difference between two groups. Conclusion: Doppler measurements for uterine artery showed higher efficacy as compared to umbilical artery and middle cerebral artery findings. Among different umbilical artery measurements, umbilical artery RI was observed to be the most efficient even at early stage (30 weeks). The findings in this study suggested Color Doppler findings have their significance for finding FGR even at the earliest stage (30 weeks).