• Users Online: 3572
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 257-260

Color doppler evaluation in high-risk pregnancies and perinatal outcome


1 Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, India
2 Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, India
3 PG student, Jawaharlal Nehru Medical College

Date of Submission21-Dec-2018
Date of Decision18-Nov-2020
Date of Acceptance15-Dec-2021
Date of Web Publication18-Oct-2021

Correspondence Address:
Dr. Harshika Singh
Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_25_18

Rights and Permissions
  Abstract 


Introduction: Doppler velocimetry is a rapid, noninvasive test that provides valuable information about the hemodynamic situation of the fetus and is an efficient diagnostic test of fetal jeopardy which helps in timely intervention and management of high-risk pregnancy for the better perinatal outcome. Aim: The aim of this study is to assess the role of color Doppler imaging in the prediction of high-risk pregnancies and their perinatal outcome. Objectives: The objecti evaluate the role of color Doppler in normal and high-risk pregnancies in relation to perinatal outcome. Materials and Methods: The study was carried out from August 1, 2016 to December 31, 2017 in the Department of Obstetrics and Gynecology in coordination with Central laboratory, and Department of Radiology, Jawaharlal Nehru Medical College Sawangi (M), Wardha, Maharashtra, India. A total of 120 pregnant women (study group and control group) attending a clinic in the Department of Gynecology and Obstetrics, AVBRH was examined for high-risk pregnancy. Results: There was a significant difference between the color Doppler indices of the three vessels (umbilical, uterine, and middle cerebral artery [MCA]) in the study and the control group. In women with abnormal Doppler indices, there was a high incidence of cesarean section, low-birth weight babies, low Apgar score, higher admission rate to neonatal intensive care unit. Conclusion: The color Doppler findings with abnormal indices of the uterine artery, umbilical artery, and MCA show a consistent relationship with poor perinatal outcome.

Keywords: Color Doppler, high-risk pregnancy, perinatal outcome


How to cite this article:
Singh H, Agrawal M, Bhake A, Singh R. Color doppler evaluation in high-risk pregnancies and perinatal outcome. J Datta Meghe Inst Med Sci Univ 2021;16:257-60

How to cite this URL:
Singh H, Agrawal M, Bhake A, Singh R. Color doppler evaluation in high-risk pregnancies and perinatal outcome. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Dec 4];16:257-60. Available from: http://www.journaldmims.com/text.asp?2021/16/2/257/328458




  Introduction Top


The high risk pregnancy group are categories of pregnancies where the mother, the fetus or the neonate is in the state of increased jeopardy. About 20%–30% of the pregnancies belong to this category. To improve the obstetric result, this group must be identified and given extra care. Even with the adequate antenatal and intranatal care, this small group is responsible for 70%–80% of perinatal mortality and morbidity.[1]

The principle of Doppler ultrasound was described in 1842 by Johann Christian Doppler. Identification of the pregnancies at risk for preventable perinatal morbidity and mortality is a primary goal of the obstetric care.[2] The development of Doppler ultrasound evaluation of uteroplacental and fetoplacental circulation is one of the most important achievements of modern obstetrics. Doppler velocimetry is a rapid noninvasive test that provides valuable information about the hemodynamic situation of the fetus and is an efficient diagnostic test of fetal jeopardy that helps in the management of high-risk pregnancy.[3]

Doppler techniques have been the focus of interest and research activity in obstetrics since the initial report of signals from the umbilical artery (UA) by FitzGerald and Drumm[4] The first application of Doppler velocimetry in obstetrics was reported by FitzGerald and Drumm and McCallum et al.[5] It has been long assumed that insufficient uterine, placental, and fetal circulations result in adverse pregnancy outcomes and that those abnormalities can be detected by the use of Doppler ultrasonography.[6]

Elevated impedance to blood flow in the placenta is reflected by abnormal UA velocimetry.[7] The absence or reversal of end-diastolic flow in the UA is suggestive of the poor fetal condition.[8] Fetal middle cerebral arterial Doppler assessment plays an important role in determining cardiovascular distress, fetal anemia, or fetal hypoxia. The uterine artery Doppler waveform is unique and increased resistance to the flow and development of a diastolic notch has been associated with high-risk pregnancy.[3]

The study was conducted with the aims to assess the role of color Doppler imaging in prediction of high-risk pregnancies and their perinatal outcome, and objectives to demonstrate the flow patterns and factors associated with adverse fetal outcome in high-risk pregnancy.


  Materials and Methods Top


This study was conducted in the Department of Obstetrics and Gynecology in Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra from August 1, 2016, to December 31, 2017. Total 120 cases out of which 60 cases were of normal pregnancy and 60 cases were of high-risk pregnancy of >32 weeks of gestational age.

Each patient was subjected to a thorough history taking, general physical examination, systemic examination, and obstetric examination. Then, each patient was subjected to serial color Doppler study, ultrasound examination and obstetrical examination. The color Doppler study was carried out using Wipro GE Logiq F8 with curvilinear color Doppler machine; Sysmex Coulter machine was used for complete blood counts, Randox RX Imola machine for the liver and kidney function test.

Criteria for selection

Criteria included were: pregnancy with anemia, pregnancy-induced hypertension (PIH), bad obstetric history, Rh-negative pregnancy, extreme age, >32 weeks of the period of gestation, pregnant women with any of the above combinations.

Interpretation of Doppler finding

  1. Uterine artery having a bilateral diastolic notch
  2. UA systolic/diastolic (S/D) ratio of more than 3 or more than 95 percentile of reference values, prediction interval (PI) more than 95 percentile of reference values or if the diastolic flow was absent or reversed
  3. Middle cerebral artery (MCA) PI less than the lower limit of the reference value
  4. MCA/UA ratio <1.


Following neonatal information was obtained

  1. Mode of delivery
  2. Indication of cesarean section
  3. Apgar score at 1 and 5 min
  4. Birth weight
  5. Admission to neonatal intensive care unit (NICU)
  6. Any intrauterine death or stillbirth.



  Results Top


The present study shows a maximum number of cases were of PIH and the next common presentation was of cases of pregnancy with anemia and pregnancy with Rh factor negative blood group [Table 1].
Table 1: Distribution of cases according to high risk factors

Click here to view


Maximum cases in the study group presented at gestational age between 34.1 and 37 weeks. Mean gestational age was 35.5 weeks for the study group [Table 2].
Table 2: Distribution of cases according to gestational age

Click here to view


Thirty-seven patients in the study group presented with anemia. Out of them 18 had a mild degree of anemia, 16 had moderate, and 03 had severe degree of anemia [Table 3].
Table 3: Distribution of cases according to degree of Anamia

Click here to view


The mean resistance index (RI), pulsatility index (PI) and S/D ratios in the study group of the right uterine artery were 0.5, 0.98 and 2.07, respectively, and mean RI, PI, and S/D ratios in study group of left uterine artery were 0.57, 1.12, and 2.14 in comparison with control group which showed values of 0.48, 1.08, 1.17, and 0.52, 1.13, 1.26, respectively. Value of S/D of right uterine and left uterine artery came out to be significant while RI and PI of both arteries are insignificant [Table 4].
Table 4: Distribution of cases according to Doppler indices of uterine artery

Click here to view


The mean RI, PI, and S/D ratios in the study group UA were 0.67, 1.33, and 2.56 in comparison with control group which showed values of 0.72, 1.53, and 1.62. Value of S/D of UA came out to be significant while RI and PI of both arteries are insignificant [Table 5].
Table 5: Distribution of cases according to Doppler indices of umbilical artery

Click here to view


The mean RI, PI, and S/D ratios in the study group MCA were 0.85, 1.86, and 2.40 in comparison with control group which showed values of 0.98, 2.48, and 3.1. S/D, RI and PI of MCA were reported as significant in the study [Table 6].
Table 6: Distribution of cases according to doppler indices of MCA

Click here to view


In the study group, 75% of the cases underwent lower segment cesarean section (LSCS), while only 23% cases in the control group had LSCS. Seventy-five percent patients in the control group had normal vaginal delivery [Table 7].
Table 7: Mode of delivery in study and control group

Click here to view


In the study group, 43 women delivered low birth weight (LBW) baby, while only 12 LBW baby got delivered by control group pregnant women. The mean birth weight in the study group was 2.01 kg, whereas in the control group, it was 2.57 kg [Table 8].
Table 8: Mode of delivery in study and control group

Click here to view


Apgar score and amniotic fluid index was significantly lower in study group as compared to control group [Table 9]. Eighty-eight percent of the pregnant females had a poor outcome in the study group as compared to 5% of pregnant female having poor outcome in control group [Table 10].
Table 9: Comparison of Apgar score and amniotic fluid index in study and control group

Click here to view
Table 10: Comparison of Apgar score and amniotic fluid index in study and control group

Click here to view



  Discussion Top


In the present study, the mean age was 24.6 years for the study group and 25.2 years for control group. Majority of the patients in study group had PIH alone or PIH with anemia and the second most common presentation is pregnancy with anemia and Rh-ve blood group. In the present study S/D value of the uterine artery, UA showed significantly higher values in the study group as compared to the control group indicating increased peripheral resistance and consequently decreased diastolic flow leading to fetal compromise. The PI, RI, and S/D ratios of MCA in the high risk pregnancy group were significantly lower than that in the control group, indicating an increase in the diastolic flow and cerebral vasodilatation and suggesting brain sparing effect in the presence of fetal hypoxia due to placental insufficiency. In the present study, most of the women in the control group had Normal vaginal delivery (75%) while in the study group majority of the women had LSCS (75%) thus indicating increased operative intervention in the study group based on abnormal Doppler velocimetry. The mean birth weight and the Apgar score were lower in the study group as compared to the control group and the difference was highly significant (P < 0.001).

In the present study, there was a higher admission rate to the NICU (66%) in the study group as compared to the control group (7%). The umbilical and MCA artery indices were abnormal in the group whose babies were admitted in the NICU as compared to those whose babies were not admitted. This implied poor perinatal outcome in the presence of abnormal indices and hence in the presence of fetal anoxia.

In 1994 Merchant et al.[9] conducted a study on color Doppler evaluation of uteroplacentofetal circulation in the management of high-risk pregnancies in which 75 high-risk pregnancies in whom color Doppler evaluation of the uteroplacental circulation was determined and correlated with perinatal outcome. Out of the 75 fetuses studied, 33 (44%) had abnormal FVWs and only 30.3% of these had an uncomplicated outcome as compared to 81% of those with normal flows.

Bansal et al.[1] conducted a study in 2010 on role of pan vessel Doppler study in high risk pregnancy and concluded that in women with abnormal Doppler indices, there was high incidence of cesarean section (78%), LBW, low Apgar score, higher admission rate to NICU (36%) as compared to that of the control group, which is in concordance with our study.

Urmila and Beena[3] conducted a study in 2010 on triple vessel wave pattern by Doppler studies in normal and high-risk pregnancies and perinatal outcome and concluded that there was a high incidence of LSCS and NICU admissions in the study group as compared to control group which is similar to findings of our study.

In 2015, Reddy et al.[10] conducted a study with the aim of antepartum detection of the fetus at risk of death or compromise in utero. 40 pregnant women with a high-risk factor and 40 control cases were included in the study who were at 34 weeks of gestation. Study concluded that both uterine and UA Doppler velocities correlated well with the perinatal outcome, but abnormal uterine artery Doppler predicts adverse neonatal outcome better than fetal vessels.

Amin et al.[11] conducted a study in 2016 on color Doppler ultrasonography in high-risk pregnancies and concluded that among 46 pregnancies with abnormal Doppler, the perinatal mortality and morbidity was 41.3% and 23.9%, respectively, as compared to patients with normal Doppler waveforms with 3.7% perinatal mortality and 11.1% morbidity.


  Conclusion Top


There was high incidence of cesarean section due to fetal distress, LBW, increased incidence of nursery admissions and low Apgar score at 1 and 5 min with abnormal Doppler indices in the study group. Thus, the study concludes that color Doppler study can be used as an adjunct in predicting high-risk pregnancies with the adverse perinatal outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bansal A, Choudhary J, Gupta H. Role of panvessel Doppler study in high risk pregnancy. J Dent Med Sci 2015;14:90-3.  Back to cited text no. 1
    
2.
Anshul D, Neelu S, Suneeta G. Significance of umbilical artery Doppler velocimetry in the perinatal outcome of the growth restricted fetuses; The Journal of Obstetrics and Gynecology of India 2010;60:38-43.  Back to cited text no. 2
    
3.
Urmila S, Beena B. Triple vessel wave pattern by Doppler studies in normal and high risk pregnancies and perinatal outcome. J Obstet Gynecol India 2010;60:312-6.  Back to cited text no. 3
    
4.
FitzGerald DE, Drumm JE. Non-invasive measurement of human fetal circulation using ultrasound: A new method. Br Med J 1977;2:1450-1.  Back to cited text no. 4
    
5.
McCallum WD, Olson RF, Daigle RE, Baker DW. Real time analysis of Doppler signals obtained from the fetoplacental circulation. Ultrasound Med 1977;3:1361-4.  Back to cited text no. 5
    
6.
Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol 2006;28:802-8.  Back to cited text no. 6
    
7.
Divon MY. Umbilical artery Doppler velocimetry: Clinical utility in high-risk pregnancies. Am J Obstet Gynecol 1996;174:10-4.  Back to cited text no. 7
    
8.
Miller J, Turan S, Baschat AA. Fetal growth restriction. Semin Perinatol 2008;32:274-80.  Back to cited text no. 8
    
9.
Merchant RH, Lulla CP, Gharpure VP. Color Doppler evaluation of uteroplacentofetal circulation in management of high risk pregnancies. Indian Pediatr 1994;31:511-7.  Back to cited text no. 9
    
10.
Reddy A, Malik R, Mehra S, Singh P, Ramchandran L. Correlation of Doppler studies at 34 weeks of gestation with perinatal outcome in high risk pregnancies. Int J Reprod Contracept Obstet Gynecol 2015;4:1894-9.  Back to cited text no. 10
    
11.
Amin B, Rahi S, Bashir A, Sidiq MM, Bhanu A. Color Doppler ultrasonography in high risk pregnancies. Int J Obstet Gynaecol Res 2016;3:481-90.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed318    
    Printed36    
    Emailed0    
    PDF Downloaded34    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]