The role of umbilical artery Doppler analysis in estimating perinatal morbidity and mortality in hypertensive pregnancy

Abstract

Aims: Uteroplacental (uterine artery systolic/diastolic (S/D) ratio) and fetal circulation changes (umbilical artery pulsatility Index (PI) value) can be evaluated non-invasively by using Doppler ultrasonography spectral analysis. The present study aimed to demonstrate how Doppler ultrasonography should be combined with classical well-being tests to detect perinatal morbidity and mortality in hypertensive pregnancy. Methods: This prospective research was carried out with 88 pregnant women diagnosed with high-risk pregnancy and hypertension between April 1992 and May 1994. A non-stress test (NST) was performed in all cases, and fetal distress was evaluated by a biophysical profile (BP) and/or a contraction stress test (CST) subsequent to a non-reactive NST. Following the diagnosis of hypertension, longitudinal maternal (uterine artery) and fetal (umbilical artery) Doppler analyses were initiated at 7–10-day intervals. In the study, the Acuson 128 XP 10 device (Research project No. 515/080555592 was funded by the İstanbul University Research Fund) and a 3.5-5 MHz curvilinear probe were used. No Doppler pathology was considered solely in the timing of delivery. Results: There was no case of perinatal loss, antepartum and intrapartum fetal distress, neonatal asphyxia, and oligohydramnios in the group with normal uterine and umbilical artery Doppler analyses. There was one case with umbilical artery Doppler flow pathology only, which was delivered by preterm cesarean section with the diagnosis of antepartum fetal distress. Fetus diagnosed to have a fetal growth restriction (FGR) and the findings of fetal distress, FGR, and cesarean delivery were concordant with the literature. There was also increased perinatal mortality (9.1%) among patients with pathological uterine artery Doppler and normal umbilical artery Doppler group, but there was no case of oligohydramnios in this group and the rate of neonatal asphyxia (5.min Apgar score <7) was 21.7%. The antepartum loss was 27%, the neonatal loss was 23.8%, and perinatal mortality was 44.8% in the group with pathological uterine and umbilical artery Doppler findings, and this group had all cases of oligohydramnios. Conclusion: Overall, it seems reasonable to identify any pathologies with Doppler ultrasonography in hypertensive pregnant women in the early pregnancy and to follow them up with classical fetal antepartum surveillance tests at appropriate intervals related to their umbilical artery Doppler pathologies.