Umbilical and fetal Middle Cerebral artery Doppler in Patients with Pregnancy Induced Hypertension in the Prediction of Adverse Perinatal Outcome

Abstract

Abstract Context Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Close antenatal care is considered the corner stone in early diagnosis of the disease and picking up of the severe cases with subsequent early management and intervention. On the other hand aggressive management of severe cases of high risk pregnancy is considered the second line of defense against maternal and preinatal morbidity and mortality. Objective The aim of this work is to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester. Methodology In this study which included 100 women with pregnancy induced hypertension who admitted to Ain Shams university maternity hospital our aim was to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester including predicting admission to NICU and the duration of treatment, low Apgar score at 5 minutes, Gestational age at delivery, fetal weight at birth and perinatal mortality. Results There was a significant association between MCA PI abnormalities and higher rates of NICU admission, 5-minutes Apgar score < 7, Low gestational age at delivery, Low birth weight and perinatal mortality. We found that the MCA PI for prediction of NICU admission was the best with (sensitivity 86.8 %, specificity 55.3 %, PPV 68.7%, NPV 78.8%).This was more predictive than either the UA-PI or the MCA/UA PI ratio. In our study, MCA PI was found to be a good predictor of poor neonatal outcome in patients with pregnancy induced hypertension especially in prediction of perinatal mortality and incidence of NICU admission. Conclusion Middle cerebral artery pulsatility index is more sensitive and more sensetive than umblical artery pulsatility index and middle cerebral arery/ umblical artery pulsitility index ratio in prediction of adverse perinatal outcomes. However middle cerebral arery / umblical artery pulsitility index ratio showed more specificity in predection of perinatal outcome in patients with pregnancy induced hypertension.