Abstract
ObjectivesThe present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome.MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis.ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (p-value <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes.ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.
Highlights
Hypertensive disorders affect approximately 5-10% of all pregnancies worldwide [1]
Pulsatility Index (PI) Cerebro Placental Ratio (CPR) had the highest sensitivity (84.8%), and the existence of early diastolic notch of Uterine Artery (UtA) and Middle Cerebral Artery (MCA)-PI were most specific in diagnosing adverse perinatal outcomes
As per the classification recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, hypertensive disorders in pregnancy are classified as chronic hypertension, preeclampsia-eclampsia, pre-eclampsia superimposed on chronic hypertension, and
Summary
Hypertensive disorders affect approximately 5-10% of all pregnancies worldwide [1]. It is the most typical medical condition in pregnancy. As a significant risk factor of maternal and perinatal mortality and morbidity globally, it accounts for almost 10-20% of pregnancy-related mortality in low and middle-income countries [2]. Hypertension during pregnancy results in uteroplacental insufficiency. It is considered a major contributing factor in adverse post-delivery outcomes such as newborn intensive care unit (NICU) admission, low birth weight, birth asphyxia, preterm birth, perinatal death, intrauterine growth restriction and stillbirth [3]. As per the classification recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, hypertensive disorders in pregnancy are classified as chronic hypertension, preeclampsia-eclampsia, pre-eclampsia superimposed on chronic hypertension, and
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