Foetal umbilical artery doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and foetal growth restriction

Abstract

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome. Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out. Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates. Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.

Comparative Assessment of the Umbilical Artery Doppler Velocimetry and Non-Stress Test in Evaluating the Fetal Well-Being among Women with Pre-Eclampsia

“…Singh D et al and Gour et al reported that majority of their patients were belonging to the age group of (21-30) years 16,17. Another study conducted by Raj et al in which mean age of the subjects studied was 28.7 years ranging from 21-39 years, which is comparable with our study 18. In the present study; we observed that 49.1% of the cases were terminated preterm.…”

“…While few investigators have found that Doppler velocimetry is better than NST in picking up the cases which are at high risk of poor perinatal outcome. 18,34,35 Our study showed that when both NST and UA Doppler velocimetry were abnormal, baby weight and gestational age at birth were low. But NICU admissions and the perinatal/early neonatal deaths were high.…”

Can cerebroplacental ratio overcome the gaps present in the tests of antepartum foetal surveillance in improving the perinatal outcome?

“…The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively in a study conducted by Amandeep Raj et al [6] Conclusion CTG and DOPPLER are effective in predicting the abnormal perinatal outcome in their own ways, but the significant advantage of Doppler was that it showed changes earlier than CTG giving us a lead time, proving valuable to an obstetrician in giving time for emergency measures such a steroid prophylaxis, termination of pregnancy and referral to tertiary care centers where expert NICU facilities are available. NST still hold its importance in antepartum foetal monitoring due to its ease and the fact that a sudden abnormal NST is indicative of acute hypoxia.…”

“…In group A, where both tests were normal, around 22% cases belonged to PIH and in group F where both tests were abnormal, had maximum cases of oligohydramnios (29%). A study by Amandeep raj et al stated that in Group A where both test results were normal had majority of cases (58.8%) with only Foetal growth restriction and had the least morbidity and Group D which had the maximum number of cases of combined preeclampsia with FGR (73.68%), had both the test results abnormal, and had the worst perinatal outcome [6] . Abnormal Doppler indices of Middle cerebral artery and Umbilical artery were found mostly in suspicious or pathological CTG groups whereas, normal Doppler indices were found in cases of reactive NST and this was found to be highly significant.…”

Fetal heart tracing and colour doppler: A comparative analysis with respect to maternal and neonatal outcome

“…In group A, where both tests were normal, around 22% cases belonged to PIH and in group F where both tests were abnormal, had maximum cases of oligohydromnios (29%). A study by Amandeep raj et al stated that in Group A where both test results were normal had majority of cases (58.8%) with only Foetal growth restriction and had the least morbidity and Group D which had the maximum number of cases of combined preeclampsia with FGR (73.68%), had both the test results abnormal, and had the worst perinatal outcome [6] .…”