Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome

Konwar, Ranjumoni; Basumatari, Bharati; Dutta, Mousumi; Mahanta, Putul; Saikia, Ankumoni; Uk, Rashmi

doi:10.7759/cureus.18888

Cited by 9 publications

(11 citation statements)

References 18 publications

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“…It was also observed that the abnormal CPR values were seen significantly higher in women diagnosed with severe hypertension (BP≥160/110) than non-severe hypertension (58.5% vs. 16.3%). Similarly, research by Konwar et al [15] found that mean CPR was significantly lower in cases of severe pregnancy-induced hypertension (PIH) compared to mild PIH cases, consistent with the findings of the present study. Studies focusing on pre-eclampsia and gestational hypertension have also noted variability in Doppler indices corresponding to the severity of the disease [14][15][16] .…”

Section: Resultssupporting

confidence: 93%

Fetal prognosis unveiled: Examining cerebro-placental ratio via doppler ultrasound in hypertensive pregnancy for predictive insights

Sarbhai,

Chaudhary

2024

Int. J. Clin. Obstet. Gynaecol.

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Background and Aim:In hypertensive disorders of pregnancy, defective placentation leads to an increase in vascular resistance in the uteroplacental circulation, which can lead to decreased uteroplacental perfusion. Cerebro-placental ratio (Doppler ultrasound) incorporates data of both umbilical artery (Placental status) and the middle cerebral artery (Fetal response) and is a better index than using either of them alone for predicting adverse fetal and neonatal outcome and help us in improving fetal and neonatal outcomes. Materials and Methods:A prospective observational study was done in a teaching hospital after taking ethical clearance from Institutional Review Committee. A total of 200 hypertensive pregnant women between 36-40 weeks of gestation underwent doppler ultrasound, and CPR ratio < 1 (done within one week of delivery) was considered abnormal. Results:The study showed that the rate of adverse fetal and neonatal outcome was high in women with abnormal CPR than with normal CPR. In women with abnormal CPR increased rate of oligohydramnios (16.4% vs. 8.3%), fetal growth restriction (98.2% vs. 42.8%), rate of caesarean section delivery (90.9% vs. 46.9%), LSCS for fetal distress (63.82 vs. 46.51%), low birth weight (87.3% vs. 31.7%), Apgar score less than 7 at 5 minutes of birth (80.8% vs. 13.2%), need of resuscitation (100% vs. 41%), NICU admission (100% vs. 36.8%), early neonatal death (21.8% vs. 2.1%), late neonatal death (10.9% vs. 0.7%). Conclusion:The cerebroplacental ratio in hypertension in pregnancy can provide useful information regarding fetal well-being and help us in improving fetal and neonatal outcomes.

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Section: Resultssupporting

confidence: 93%

Fetal prognosis unveiled: Examining cerebro-placental ratio via doppler ultrasound in hypertensive pregnancy for predictive insights

Sarbhai,

Chaudhary

2024

Int. J. Clin. Obstet. Gynaecol.

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“…Similar findings were reached by Konwar et al (14) they found that severe PIH cases had significantly higher Mean UmA-RI than moderate PIH cases (P<0.05). The MCA-Resistive Index (RI) value was substantially different between patients with mild and severe PIH, with the RI being lower in severe PIH than in mild PIH or normal PIH (P<0.01).…”

Section: Discussionsupporting

confidence: 88%

Study of Use of Shear Wave Elastography in Placental Dysfunction by Comparison of Elasticity Values in Normal and Pre-eclamptic Pregnancies

Gebally¹,

Elsammak²,

Refaat³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: It has been believed that placental stiffness varies between normal and pre-eclamptic pregnancies. In order to appreciate this difference, Share Wave Elastography (SWE) of the placenta was done to assess the degree of placental stiffness. Objective: The aim of the current study was to evaluate the utility of SWE in detection of preeclampsia and correlate the degree of placental stiffness with severity of pre-eclampsia and with perinatal outcome. Patients and methods: A total of 76 pregnant females in second or third trimester were enrolled in the present study. Half of them (38 females) had normal pregnancy with no history of medical disease and the second half (38 females) had pregnancy complicated by pre-eclampsia. SWE was used for all cases. Results: In pre-eclamptic placentas, the mean stiffness values were significantly higher across all regions and layers compared to healthy controls. The central placental region showed the greatest disparity. A moderate correlation was also found between the severity of pre-eclampsia and SWE data. Maximum diagnostic accuracy was achieved with a cutoff of 18.47 kPa for the central placenta (area under the curve: 0.97; confidence interval: 0.88-1; sensitivity: 94.7%; specificity: 94.7%; PPV 92.3; and accuracy: 94.7%). Regarding other obstetric and Doppler findings there was a significant decrease in measured abdominal circumference AC and femur length FL among preeclamptic pregnancies compared with the control group, together with abnormal Doppler indices with highly statistical significant increase of resistive index of umbilical artery and significant decrease of resistive index of middle cerebral artery among preeclampsia patients compared to the control group. Conclusion: Difference in placental stiffness between healthy and pre-eclamptic pregnancies can be assessed using SWE, and it can be used for mentoring early perinatal outcome together with routine obstetric and Doppler ultrasound study.

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“…Similar findings in agreement with our study were noted in the study done by Lakhkar et al and Konwar et al in PIH patients but were low as compared to our study for predicting adverse perinatal outcome. 14,15 Results show all patients with AEDF/REDF resulted in early pre term birth and low birth weight, poor APGAR score, large numbers of NICU admission (93.7% cases) and increased need for positive pressure ventilation during NICU stay (43.7% cases). Also, higher incidence of babies developing sepsis (31.2%), intraventricular haemorrhage (50% cases), necrotizing enterocolitis (37.5% cases), IUD and neonatal death were noted in patients with AEDF/REDF, making them ominous signs during ANC Doppler surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…Findings consistent with our study were observed in the study by Gaikwad et al and Lakhkar et al but incidences were higher in our study likely because EOPE is more severe disease and carry higher risk for perinatal adverse outcomes. 13,14 [13][14][15][16] In our study 8.3% cases showed abnormally low resistance MCA Doppler parameters signifying fetal brain sparing effect (fetus redistributes its cardiac output to maximise oxygen and nutrient supply to the brain) (Figure 4) as demonstrated by Konwar et al and Cohen et al MCA PI, RI and S/D ratio showed 100% specificity and PPV with diagnostic accuracy of 40%, but couldn't reach statistical significance as p value was 0.143 for predicting adverse perinatal outcome (Figure 4). 15,17 To increase sensitivity of MCA Doppler parameters, serial Doppler examinations of MCA in combination of umbilical artery are required so that fetal decompensation cases are not missed out, where MCA Doppler velocimetry starts increasing just before fetal demise.…”

Section: Discussionmentioning

confidence: 99%

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Study of fetomaternal arterial doppler parameters in early onset pre-eclampsia and its correlation with perinatal outcomes

Verma

Tomer

Solanki

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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Background: Development of pre-eclampsia (PE) at less than 34 weeks of gestation is known as early onset PE (EOPE) and is commonly associated with more severe adverse maternal and fetal outcomes. The purpose of this study was to study Doppler parameters of uterine, umbilical and fetal middle cerebral arteries exclusively in women with EOPE and its correlation with perinatal outcomes. This study was a hospital-based observational prospective study.Methods: 60 patient of early onset PE with singleton live pregnancy were included in the study and followed up. The results of sonographic and Doppler examination were analysed and correlated with perinatal outcomes.Results: Adverse perinatal outcomes were seen in 66.66% cases of early onset PE. To predict adverse perinatal outcomes, umbilical artery (Umb A) RI, PI were found to be most sensitive, cerebroplacental ratio (CPR) was most specific indicator with highest positive predictive value (PPV). Absent end diastolic flow /reverse end diastolic flow (AEDF/REDF) were ominous signs.Conclusions: Early onset PE is recently considered a more severe disease with different etiopathogenesis. Doppler study is the primary imaging modality for fetomaternal surveillance for follow up and prediction of perinatal outcome, thus allowing planning of timely management in early onset PE patients, as these patients are at higher risk of adverse perinatal outcomes.

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Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome

Cited by 9 publications

References 18 publications

Fetal prognosis unveiled: Examining cerebro-placental ratio via doppler ultrasound in hypertensive pregnancy for predictive insights

Fetal prognosis unveiled: Examining cerebro-placental ratio via doppler ultrasound in hypertensive pregnancy for predictive insights

Study of Use of Shear Wave Elastography in Placental Dysfunction by Comparison of Elasticity Values in Normal and Pre-eclamptic Pregnancies

Study of fetomaternal arterial doppler parameters in early onset pre-eclampsia and its correlation with perinatal outcomes

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