Doppler Study In High-Risk Pregnancy: An Observational Study

Abstract

Background:The increased morbidity of high-risk pregnancies also affects the mother and the baby because of the placental insufficiency and compromised baby. The Doppler ultrasonography is a non-invasive tool to assess fetal and placental circulation and is an important tool for early detection of adverse perinatal outcome. The purpose of this study was to determine the predictive value of Doppler velocimetry of the umbilical artery (UA) and middle cerebral artery (MCA) in the evaluation of the mother and fetus outcome in high-risk pregnancies.

Objective: To carry out a prospective observational study in the Department of obstetrics and gynaecology in a tertiary care teaching hospital for high-risk pregnant women.

Methods:To undertake a prospective observational study in one of the departments of obstetrics and gynaecology in a tertiary care teaching hospital of 118 high risk pregnant women. The eligible pregnancies with singleton fetuses (34 weeks' gestation or greater) were subjected to Doppler ultrasonography of the umbilical artery and middle cerebral artery. The Doppler indices such as the Pulsatility Index (PI), Resistance Index (RI) and Systolic-to-Diastolic (S/D) ratio were obtained, and a correlation was made with the maternal and neonatal outcome. The data were analysed statistically by using SPSS software 26.0 and p value was set to be statistically significant at p value < 0.05.

Results:These results showed that, pregnancy-induced hypertension (35.6%), Intrauterine growth restriction (25.4%) and gestational diabetes mellitus (18.6%) were the most prevalent high-risk conditions. Almost one-third of the subjects had abnormal Doppler signals in their umbilical artery, which was significantly associated with cesarean delivery, low birth weight, low APGAR score, admission to a NICU and neonatal death (p<0.05). The abnormal Doppler indices of umbilical artery were independent risk factors for adverse perinatal outcome in logistic regression analysis. The pulsatility index of the umbilical artery showed the best diagnostic value (AUC = 0.89) when used as a predictor of adverse outcome of the newborn.

Conclusion:Doppler ultrasonography, especially umbilical artery velocimetry, can be used as an effective reliable method in high-risk pregnancies to identify those fetuses at high risk for poor perinatal outcome. This could be achieved through the routine use of Doppler assessment as part of antenatal surveillance which would aid in the early detection of abnormalities, timely obstetric intervention and better maternal and/or foetal outcomes.