Role of umbilical artery Doppler velocimetry in predicting the adverse perinatal outcomes in hypertensive disorder of pregnancy

Abstract

Background: Early detection of fetoplacental compromise with Umbilical Artery Doppler indices and to know the predictive value of each indices in predicting perinatal outcome and interventional strategies in these patients.Methods: The present prospective study was conducted on 200 women with hypertensive disorder of pregnancy. Umbilical artery doppler evaluation done in all the patients at (28-32) weeks, (33-36) weeks and (37-40) weeks of gestation and more frequently in those patients having deranged Doppler. Patients divided into two groups women with abnormal Umbilical artery indices (group B) and normal indices (group A). Perinatal outcome of both the groups were compared, analyzed statistically using Chi-square test. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: A total of 200 pregnant women with hypertensive disorder, 64% were primgravida. Abnormal umbilical artery indices seen in 36%. Adverse outcome was seen in 88.88% patients of group B. Statistically significantly higher rate of caeserian section, induction of labour, Preterm delivery, fetal growth restriction, NICU admission, NICU stay >48hrs were seen in group B. In all indices Umbilical artery PI had highest Sensitivity (84.21%), positive predictive value (88.88%) and accuracy (90%).Conclusions: Umbilical artery PI is the most reliable to predict adverse perinatal outcomes and help in appropriate timing of intervention to improve perinatal outcome.

Doppler sonographic evaluation of intrauterine growth restriction of fetus and its correlation with perinatal outcomes among the population of riverine (char) areas of Barpeta Assam

“…Yadav et al in their study found that UA PI had 84.21% sensitivity, 88.88% positive predictive value and 90% accuracy. 8 This is consistent with the current study findings. Srirambhatla et al in their study in AIIMS Hyderabad found that MCA had a 60%, 89%, 75%, 81% and 79% sensitivity, specificity, positive predictive value, negative predictive value and accuracy respectively for adverse perinatal outcome.…”

The role of umbilical artery doppler indices in predicting perinatal outcome in preeclampsia

“…This findings are in agreement with study by Yadav et al (PI, sensitivity=84.21%, specificity=93.54%, PPV=88.88%, NPV=90.62%; S/D ratio, sensitivity=80.64%, Specificity=88.54%, PPV=76.92%, NPV=90.62%; RI, sensitivity=77.35%, specificity=87.21%, PPV=73%, NPV=90.62%), who similarly found that umbilical artery PI was a better predictor of adverse perinatal outcome among the indices. 12 This was however different from the study by Padmini et al (RI, sensitivity=95.2%, specificity=79.66%, PPV=62.5%, NPV=97.91%; S/D ratio, sensitivity=86.96%, Specificity=77.2%, PPV= 60.6%, NPV=93.6%; PI, sensitivity=75%, specificity= 98.3%, PPV=93.3%, NPV=92.19%), who found umbilical artery RI as a better predictor of adverse perinatal outcome. 17 This present study was also not in keeping with the studies by Shah et al (S/D ratio, sensitivity=66.6%, specificity=45.4%, PPV=66.6%, NPV=45.4%; PI, sensitivity=50%, Specificity=59%, PPV=66.6%, NPV= 41.9%; RI, sensitivity=44.4%, specificity=81.8%, PPV= 80%, NPV=47.3%) and Gaikwad et al (S/D ratio, sensitivity=40.54%, specificity=89.86%, PPV=68.18%, NPV=73.81%; RI, sensitivity=37.83%, Specificity= 79.71%, PPV=50%, NPV=70.51%; PI, sensitivity= 29.73%, specificity=92.75%, PPV=68.75%, NPV= 71.11%), who both found S/D ratio as a better predictor of adverse perinatal outcome.…”

“…The 12,18,20 The incidence of reduce end diastolic flow, absent end diastolic flow and reversed end diastolic flow was 34.7%, 4.1%, and 8.2% respectively. This was consistent with the findings by Mishra et al who also found an incidence of 30%, 10% and 6.7% for reduce end diastolic, absent end diastolic flow and reversed end diastolic flow respectively.…”

“…This was in keeping with several studies. 9,12,13,15,20,22 For the individual umbilical artery Doppler indices, PI was the most useful umbilical artery indices (sensitive=68.5% specificity=59.7%, PPV=74.8% NPV=52.1%) when compared to RI (sensitivity=64.8%, specificity=64.5% PPV=76.1%, NPV=51.3%), S/D ratio (53.7% specificity=79.0% PPV=81.7%, NPV=49.5%). This suggests that that umbilical artery PI is a better predictor of adverse perinatal outcome in preeclampsia among the individual umbilical artery indices because it is the most sensitive of all the indices.…”

“…Several studies have shown its usefulness though with varying sensitivities and specificities. 8,9,12,[13][14][15][16][17][18][19][20] More research in this area is therefore imperative to establish the usefulness of this investigation as a screening tool to predicting adverse perinatal outcomes in preeclampsia. More so, there is a paucity of prospective studies on UAD, in this part of the world, to investigate this very important screening test, for this prevalent problem.…”