Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Role of Ultrasonography in Screening High Risk Mothers for Detection of IUGR

Introduction: The 10th percentile of expected foetal weight for gestational age is classified as intrauterine growth restriction (IUGR) or foetal growth restriction. IUGR occurs for a variety of reasons. Any issue with the placenta is a major contributor. Aims and objectives: 1) To determine the role of ultrasonography in screening high risk mothers for detection of IUGR. 2) To find out the impact of fetal parameters on the extent of IUGR.3) For correlation between sonographic pattern of IUGR and the birth weight. 4) For correlation between doppler parameters and perinatal outcome. Materials and methods: This is a prospective study done over a period of 2 years in Mamata General Hospital (MGH) from Oct 2017 to Oct 2019. Study included 50 pregnant women with high risk factors and clinically suspected IUGR attending for ultrasound examination were subjected to Uterine, Umbilical and Middle cerebral artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria. Results: Reverse, absence or slow end diastolic flow was considered abnormal which was seen in 33 patients. Nine patients had Absent /Reversed end diastolic flow of which, 3 patients had IUD, 4 had Still births, 2 were admitted in NICU with apgar at 1min <7. Middle cerebral artery was abnormal in 10 patients, of which 8 patients had IUGR babies with adverse perinatal outcome. MCA/UA S.D ratio, which was abnormal in 19 patients of which 16 patients had adverse perinatal outcome. Conclusion: Doppler has proven to be more sensitive than other methods of foetal monitoring in recognising fetal compromises early and assisting in the proper time of delivery. Keywords: Ultrasonography, doppler, IUGR.

ROLE OF DOPPLER INDICES IN THE PREDICTION OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA

Objective: To determine diagnostic accuracy of systolic/diastolic ratio and cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2017. Methodology: A total of 191 patients with preeclampsia were included. Doppler ultrasound (including doppler wave forms obtained from free floating portion of umbilical artery and doppler waveform from middle cerebral artery at the level of circle of Willis) examination was done after gestational age 30 weeks and Doppler study repeated at 2-4 weeks interval depending on severity of preeclampsia and abnormalities of waveform. Cases were followed and results of last Doppler examination within 10 days of delivery were considered and perinatal outcome noted. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of systolic/diastolic ratio in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 82.35%, 86.52%, 87.50%, 81.05% and 84.29% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 78.67%, 92.24%, 86.76%, 86.99% and 86.91% respectively. Conclusion: The diagnostic accuracy of systolic/diastolic ratio, cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia is quite high.

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

<b><i>Objectives:</i></b> The objectives of this study were to evaluate the diagnostic abilities of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome (APO) and cesarean section for intrapartum fetal compromise (CS-IFC) within 1 day of delivery. <b><i>Design:</i></b> Retrospective observational case-control study. <b><i>Methods:</i></b> This was a study of 254 high-risk fetuses attending the day hospital unit of a tertiary referral hospital that underwent an ultrasound examination at 32–41 weeks and gave birth within 1 day of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH &#x3c;7.20 requiring urgent cesarean section, neonatal umbilical cord pH &#x3c;7.10, 5-min Apgar score &#x3c;7, and postpartum admission to neonatal or pediatric intensive care units. CS-IFC was defined in case of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH &#x3c;7.20 requiring urgent cesarean section. The diagnostic ability of CPR for the prediction of APO and CS-IFC was calculated alone and in combination with estimated fetal weight and gestational clinical parameters, including the type of labor onset, using ROC curves and logistic regression analysis. <b><i>Results:</i></b> CPR in multiples of the median (MoM) was a moderate predictor of APO (area under the curve [AUC] = 0.77, <i>p</i> &#x3c; 0.0001) and CS-IFC (AUC = 0.82, <i>p</i> &#x3c; 0.0001). The predictive abilities of the multivariable model for APO (AUC = 0.81, <i>p</i> &#x3c; 0.0001) and CS-IFC (AUC = 0.82, <i>p</i> &#x3c; 0.0001) did not differ from those of CPR alone . <b><i>Limitations:</i></b> The small number of cases and the scarcity of information concerning labor induction. <b><i>Conclusion:</i></b> In high-risk pregnancies, CPR MoM is a moderate predictor of APO and CS-IFC when performed within 24 h of delivery.