ABSTRACT
Background: Pre-eclampsia is a pregnancy specific disorder characterized by hypertension and proteinuria after 20 weeks of gestation. Uterine artery Doppler velocimetry analysis has been extensively studied in the second trimester of pregnancy as a predictive investigation for the future development of pre-eclampsia and Fetal Growth Restriction.Aims: To predict the probability of developing pre-eclampsia of pregnant women and Fetal Growth Restriction in relation with normal and abnormal Doppler velocimetry of uterine artery at 2nd trimester of pregnancy.Methods:A total of 97 pregnant women of 2nd trimester of pregnancy were included in this study After taking informed written consent of the participants, all they underwent uterine artery Doppler velocimetry at 22ndand 24thweek of pregnancy. They again examined clinically during delivery at different gestational age. Pre-eclampsia (PE) was diagnosed on the basis of measurement of blood pressure as well as urine routine and microscopic examination. Fetal Growth Restriction (FGR) was determined by measuring birth weight and gestational age at the time of delivery. Development of PE and FGR was observed in relation to severity of Uterine Artery Doppler Velocimetry findings. A pre-structured data collection sheet was used as a research tool for data collection. Statistical analyses of the results were obtained by using windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-23).Results: More than half (52.6%) of the subjects belonged to age 21-25 years and 52(53.6%) subjects were nulliparous. More than half (56.7%) of the subjects came from low income group family. Pre-eclampsia developed 11(11.3%) of the patients, 15(15.5%) had FGR and 12(12.4%) had notching in 2ndUADV at 24thweek. Presence of Pre-diastolic notch in 2ndUADV study at 24thweek to predict pre-eclampsia has sensitivity 72.7%, specificity 95.4%, accuracy 92.8% and positive predictive values 66.7% and negative predictive value 96.5%. Presence of Pre-diastolic notch in 2ndUADV study at 24thweek to predict FGR has sensitivity 20.0%, specificity 89.0%, accuracy 78.4% and positive predictive values 25.0% and negative predictive value 85.9%. The mean age was 28.69±7.81 years who had per-diastolic notch in 2ndUADV at 24thweek and 24.13±6.11 years who had normal UADV and the p value is 0.022 which is significant. The mean para was 1.29±0.33 who had per-diastolic notch in 2ndUADV at 24thweek and 1.77±0.29 who had normal UADV together with remarkable p value which is 0.001. The mean BMI was 23.59±1.09 Kg/m2who had per-diastolic notch in 2ndUADV at 24thweek and 21.57±0.47 Kg/m2who had normal UADV with notable p value 0.001 in this study.Conclusion:Uterine artery Doppler velocimetry in early pregnancy can be a good investigating tool for prediction of subsequent development of pre-eclampsia and Fetal Growth Restriction
ABSTRACT
Background:The worldwide obesity epidemic continues to be a major public health challenge, particularly in women of childbearing age. There is a need to understand the associations between maternal BMI and perinatal outcome.Objectives: To evaluate recent trends in maternal body mass index (BMI) and to quantify its association with foetal outcome.Methodology: It is a cross sectional study including a total of 384 pregnant women who were primi gravida and carry singleton pregnancy admitted at term in the department of Obstetrics and Gynaecology of DMCH for the management of labour. All the mothers were chosen by purposive sampling. The study populations were classified into four groups according to BMI. Group-I stands for 44 mothers who are underweight, Group-II consists of 234 mothers who are normal weight, Group III represents to 81 mothers who are overweight and Group IV signifies for 25 mothers who are obese. The women with multiple pregnancies, preterm labour and hypertension or diabetes were excluded from the study. Data regarding socio demographic, clinical, obstetrical and foetal outcome were recorded, afterwards the data were edited, managed and analyzed. The observations were plotted into tabular and figure form. The categorical variable was analyzed by chi square test and the quantitative variables were analyzed by ANOVA test. At all level 95% confidence interval & level of significance was p <0.05. The statistical analysis wasdone by SPSS version 23.Results: The mean BMI of mothers in different groups (Group I, Group II, Group III and Group IV) were 18.37±1.06kg/m2, 23.77±2.03kg/m2, 26.54±2.47kg/m2and 32.15±1.17kg/m2respectively. The average BMI of total 384 mothers was 22.75±4.56kg/m2. The highest 84% newborn had birth weight >2.5kg in Group IV whereas 72.7% had ≤2.5kg birth weight in Group I. Maximum (57%) mothers underwent NVD in Group I as long as the paramount (71%) mothers endured LSCS in Group III. Out of 384, total 180(46.9%) mothers had NVD and 204(53.1%) mothers deferredLSCS. APGAR score ≤7 was found 31.8%, 12.8%, 38.3% and 20% in Group I, Group II, Group III and Group IV independently. The P-value showed statistically significant of the groups (P=0.00016). Among 204 LSCS, 167(81.9%) mother sustained emergency and 37(18.1%) undertook elective LSCS. 52.9% of mothers went through LSCS were due to meconium staining liquor in Group IV which was subsequently followed by 46.6% in Group-III. 25.0%, 9.8%, 32.1% and 16% neonates required NICU admission in Group I, Group II, Group III and Group IV severally. There was a moderately positive significant correlation between maternal BMI and neonatal birth weight (r=+.383, p<0.001). All the statistics of requirements of NICU between one another group showed statistically significant difference.Conclusion: Our study shows that maternal BMI has an effect on foetal outcome. Low BMI is associated with adverse perinatal outcome in terms of low birth weight while high BMI is associated macrosomia, LSCSand neonatal NICU admission. Regarding NICU requirements overweight mothers had more association with foetal outcome rather than obese. Therefore, definitely there is a role of pre pregnancy counseling regarding maintenance of weight of women especially during reproductive age group to maintain normal BMI as to have better perinatal outcome