ABSTRACT
Background: Preeclampsia occurs in presence of placenta. Blood supply distribution within the uterus is not similar in central versus lateral sites implicating that, the site of placenta is likely to have a profound effect on the pregnancy outcome. In the light of these observations, a prospective study was designed to find out if the lateral location of placenta as seen by ultrasound between 18-24 weeks of gestation can be used to predict the development of preeclampsia.Methods: This prospective study was conducted in the department of Obstetrics and Gynaecology in IGGMC, Nagpur between January 2017 and June 2018. Pregnant women, with singleton pregnancy and without any risk factor, attending the antenatal clinic were subjected to USG between 18-24 weeks of gestation. Accordingly, patients were divided into 2 groups, 51 with lateral placenta and 51 with central placenta. All 102 women were followed till term. The end point of the study was development of preeclampsia i.e. BP >140/90 and urine albumin >300 mg in 24 hours sample. The data obtained was analysed using appropriate statistical tests.Results: Out of 102 patients, 80.9% were from lateral placenta group and only 19.1% were from central placenta. Sensitivity of this as screening test for preeclampsia was 80.9% while specificity was 58%, Odds ratio being 5.875. In predicting preeclampsia, lateral placenta had a meaningful effect with p value <0.001.Conclusions: Placental laterality, as determined by USG between 18-24 weeks of gestation, is a simple and cost-effective screening test for development of preeclampsia.
ABSTRACT
Background: Hypertensive disorders remain the most common medical complication during pregnancy and contribute greatly to maternal and perinatal morbidity and mortality. Several tests have been proposed to identify the women at risk of developing hypertension. Among the various predictors, the placental location by USG at 18-24 weeks is cost effective, non- invasive and has a good positive predictive value. The present study was undertaken to predict the association of placental location with the development of hypertension in pregnancy.Methods: This was a longitudinal cohort study conducted on 380 uncomplicated primigravid women who attended the obstetric OPD of MGMC&RI over a period of 18 months (March 2017-august 2018). A detailed history was taken, and examination done and B.P. was measured. The placental location was determined by ultrasound at 18-24 weeks and the patients were divided into two groups : group A were women with lateral placenta and group B were women with other placental locations. All women were followed up for signs and symptoms of hypertensive disorders of pregnancy and mode of delivery and neonatal outcome were noted.Results: Out of 380 women, 56(14.7%) had lateral placenta and 324(85.3%) had other placental locations. Out of the 57 women who developed hypertensive disorders in pregnancy, 16(28.6%) had lateral placenta and 41(12.7%) had other placental locations. The risk of developing hypertension in pregnancy with lateral placenta was 3.5(odds ratio) with a 95% confidence interval (1.4-8.6). The sensitivity, specificity, positive predictive value and negative predictive value when placental laterality is used as a predictive test was 28.1%, 87.6%, 28.6% and 87.4% respectively.Conclusions: The placental laterality as determined by ultrasound at 18-24 weeks is a simple, non-invasive, cost-effective predictive test to predict women at high risk of developing hypertensive disorders of pregnancy and this test has a high specificity and negative predictive value.
ABSTRACT
Background: Placental abnormality is one of the initial events seen in patients who are destined to develop preeclampsia. The objective was to study whether ultrasonically identified; placental laterality and uterine artery resistance can be used as a predictor for development of preeclampsia. Methods: This prospective observational study was conducted at GMERS Medical College, Dharpur-Patan tertiary care teaching institute in North Gujarat from January 2013 to December 2014. A total 400 non high risk primigravida with singleton pregnancy were included, all patients with diabetes, hypertension, renal disease, and history of smoking were excluded. In all these patients, location of placenta was determined by ultrasonography at 18 to 22 weeks of gestation. Patients who had lateral placenta were subjected for colour Doppler study for determining uterine artery resistance index. All 400 patients were followed till delivery for occurrence of preeclampsia as per ACOG guidelines. All data was analyzed and statistical significance was determined by x2 test and value of p<0.05 is considered significant. Results: Out of 400 cases, 80 (20%) cases had laterally located placenta on ultra sound examination done at 18-24 weeks of gestation. Out of the 80 women with laterally located placenta, 28 (35%) developed preeclampsia. This relationship was statistically significant. All 80 patients who had lateral placenta, 26 patients had raised uterine artery resistance and out of those 26 patients, 22 developed preeclampsia and 54 had no change in uterine artery resistance. Out of those 54 only 6 had preeclampsia (p<0. 001). The sensitivity of determining uterine artery resistance as a predictive test was 84.6%, the specificity 88.8 %, positive predictive value 78.5 % and negative predictive value 92.3%. Conclusion: A chance of preeclampsia is more in patients with lateral placenta but its sensitivity and specificity increases significantly when it is combined with uterine artery velocimetric waveform study, and we can predict preeclampsia in patient who is having lateral placenta and raised uterine artery resistance.