Abstract
Objective: To demonstrate the flow patterns and factors associated with adverse foetal outcome in high-risk pregnancy at Mulago Hospital using Doppler ultrasound of the foetal umbilical artery. Design: Cross-sectional descriptive study. Setting: Mulago National Referral Hospital, Kampala Uganda. Study Subjects: One hundred and ninety-two patients in a 4-month period (December 2008-April 2009). Results: Maternal age was 16 to 41 years. Twenty-one foetuses had abnormal flow patterns (12 had reduced end-diastolic flow, 8 had AEDF and 1 had RF). Prematurity was associated with abnormal flow patterns. 11 out of 12 foetuses with reduced end-diastolic flow survived. Of the foetuses with AEDF, 3 survived but were admitted to the neonatal special care unit while 5 died. One foetus had RF and was a stillbirth. Eighteen foetuses were delivered after an obstetric intervention. Conclusions: 1) The prevalence of abnormal flow patterns is 10.9%. 2) Abnormal flow patterns, low biophysical profile score, premature delivery, low birth weight and low Apgar score are related to adverse foetal outcome. 3) A low biophysical profile score is related to AEDF/RF. 4) Foetuses of low parity mothers are more likely to have abnormal flow patterns. Recommendation: Umbilical artery Doppler Biophysical profile scores should be done in high-risk pregnancy.
Highlights
High-risk pregnancy constitutes conditions that predispose to placental insufficiency
3) A low biophysical profile score is related to absent end-diastolic flow (AEDF)/reversal of flow (RF). 4) Foetuses of low parity mothers are more likely to have abnormal flow patterns
Recommendation: Umbilical artery Doppler Biophysical profile scores should be done in high-risk pregnancy
Summary
High-risk pregnancy constitutes conditions that predispose to placental insufficiency. These cause foetal compromise and are detected early by combined antepartum surveillance methods saving infant lives as well as reducing foetal disabilities [1]. The criteria for highrisk pregnancy are extremes of reproductive age (below 18 or greater than 35 years), young primigravida, high parity or short birth interval, large infants of 4 kilograms or more, prematurity, low birth weight of less than 2.5 kilograms, obstructed and difficult labours, poor obstetric history, history of reproductive tract surgery, genetic or familial diseases, medical conditions such as diabetes, cardiac or renal disease, hypertension, rhesus incompatibility, maternal disabilities, those with obstetric risks such as multiple pregnancy, malpresentations and others, antepartum haemorrhage, postpartum haemorrhage, deep vein thrombosis, intrauterine growth retardation, premature rupture of membranes, post dates and cephalopelvic disproportion [4]
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