The Value of Middle Cerebral to Umbilical Artery Doppler Ratio in the Prediction of Neonatal Outcome Among Women With Pregnancy Induced Hypertension

Abstract

Background: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality.Objective: To evaluate the role of middle cerebral artery and umbilical artery pulsatility index (PI) ratio in predicting neonatal outcome in pregnancies induced hypertension. Patients and methods:This study which included 100 women with severe preeclampsia admitted to Alsayed Galal University Hospital during the period between November 2018 and July 2019. Were evaluated the accuracy of middle cerebral/umbilical artery pulsatility index ratio in predicting admission to neonatal intensive care unit (NICU), acidemia and low Apgar score at 5 minutes after birth in neonates of severe preeclamptic pregnant women. Results:The best cut off value of middle cerebral artery (MCA) / umbilical artery (UA) PI ratio for prediction of NICU admission was sensitivity 62.5%, specificity 71.43%, positive predictive value (PPV) 29.41%, negative predictive value (NPV) 90.91% and the accuracy 70%. The cut off value of MCA/UA PI ratio for prediction of low Apgar score at 5 min was 50% sensitivity and 88.10% specificity. Estimated positive predictive value =44.44 and negative predictive value =90.24, and the cut off value of MCA/UA PI ratio for prediction of low UA PH were 43.75% sensitivity, 69.05% specificity, estimated positive predictive value =21.21, and negative predictive value =86.57. Conclusion:Doppler data combining both umbilical and cerebral velocimetry provides information on consequences of the placental abnormality; Hence, Doppler can be a useful tool in the management of patients with preeclampsia and can help in deciding the time of delivery so that the fetus can be saved.

Fetal Middle Cerebral to Uterine Artery Pulsatility Indices Ratios in Preeclampsia versus Normal Pregnancy

“…On the other hand prediction of low Apgar score at 5 min was 50% sensitivity and PPV 44.44%. Prediction of low UA PH was 69.05% specificity and NPV 86.57% [20] .…”

Correlation Between Fetal Umbilical Artery and Middle Cerebral Artery Doppler Indices in Preeclamptic and Normotensive Pregnancies

“…These results can be compared with those obtained by Rafiq et al Their study included 126 patients with preeclampsia with a mean age of 27.48 ± 5.61 zyears, a mean gestational age of 35.05 ± 2.95 weeks, a mean systolic BP of 151.98 ± 8.88 mm Hg, and a mean diastolic BP of 96.90 ± 4.64 mm Hg. 16 Abdelrazik Abdelfattah et al 17 reported on 100 patients with preeclampsia, who had a mean age of 28.62 ± 4.27 years and a mean gestational age of 36.24 ± 1.66 weeks. Lopez-Mendez et al 15 reported on 52 patients with preeclampsia with a mean age of 30.06 ± 5.32 years, a mean gestational age of 33.39 ± 3.46 weeks, a mean gravida of 3.43 ± 1.93, a mean systolic BP of 148.33 ± 14.1 mm Hg, and a mean diastolic BP of 93.63 ± 7.94 mm Hg.…”

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

“…When the CPR was determined, it exhibited a mean value of 0.92 and a range of 0 to 1.63; anything below 1.0 was deemed abnormal, while anything over 1.0 was also deemed abnormal. Abdelrazik et al, [19] evaluated the MCA-PI and UA-PI ratio role in forecasting neonatal outcomes in pregnancy-induced hypertension. The reliability of the MCA/UA PI ratio for forecasting acidemia, admission to the NICU, and poor Apgar scores at 5 minutes after delivery in neonates of severe preeclamptic pregnant women was assessed in this research, which comprised 100 women with severe preeclampsia.…”