|Year : 2021 | Volume
| Issue : 2 | Page : 257-260
Color doppler evaluation in high-risk pregnancies and perinatal outcome
Harshika Singh1, Manjusha Agrawal1, Arvind Bhake2, Ratnesh Singh3
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 Submission||21-Dec-2018|
|Date of Decision||18-Nov-2020|
|Date of Acceptance||15-Dec-2021|
|Date of Web Publication||18-Oct-2021|
Dr. Harshika Singh
Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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.
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. 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.
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 The first application of Doppler velocimetry in obstetrics was reported by FitzGerald and Drumm and McCallum et al. 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.
Elevated impedance to blood flow in the placenta is reflected by abnormal UA velocimetry. The absence or reversal of end-diastolic flow in the UA is suggestive of the poor fetal condition. 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.
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|| |
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
- Uterine artery having a bilateral diastolic notch
- 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
- Middle cerebral artery (MCA) PI less than the lower limit of the reference value
- MCA/UA ratio <1.
Following neonatal information was obtained
- Mode of delivery
- Indication of cesarean section
- Apgar score at 1 and 5 min
- Birth weight
- Admission to neonatal intensive care unit (NICU)
- Any intrauterine death or stillbirth.
| Results|| |
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].
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].
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].
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|
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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|
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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].
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].
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].
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|
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|Table 10: Comparison of Apgar score and amniotic fluid index in study and control group|
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| Discussion|| |
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. 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. 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 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. 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. 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|| |
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
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]