Color Doppler Evaluation of Fetomaternal Circulation in Patients with Pregnancy-induced Hypertension and its Value in Predicting Perinatal Outcome

Abstract

Context and Aim: The purpose of antenatal ultrasonography (USG) is to identify women at risk of complications due to various medical conditions such as pregnancy-induced hypertension (PIH) and preeclampsia. Our aim was to describe the practical application of Doppler indices of the uterine, umbilical, and fetal middle cerebral artery (MCA) in patients with PIH by comparing them with perinatal outcome. Materials and Method: A prospective longitudinal study of 50 pregnant women with a clinical diagnosis of PIH referred for USG and color Doppler and followed for any adverse perinatal outcome till 7 days after delivery was done. Patients were examined using the convex probe of 1–5 MHz frequency on the IU22 (Philips) machine. Results: In this study, 46% of patients were in the age group of 26–30 years and 64% were multiparous. Out of 50 patients, 43 were live births and 7 stillbirths. Out of live births, 35 required neonatal intensive care unit admission and five had neonatal mortality. Umbilical artery Doppler indices were altered in 42, uterine artery in 26, and fetal MCA in nine patients. Absent and reversed end-diastolic flow in the umbilical artery, the persistence of diastolic notch in the uterine artery, and the brain-sparing effect in fetal MCA represented the most ominous signs. Doppler indices were abnormal in more than one artery in stillbirths and neonatal deaths. Conclusion: The knowledge of the uterine, umbilical, and fetal cerebral artery waveforms helps to assess compromised uteroplacental and fetoplacental circulation in patients with PIH at the earliest. Hence, the detection of altered indices should be an alerting signal for intensive fetal monitoring and prompt intervention.