Fetal cardiac dysfunction in pre-eclampsia [combined doppler ultrasonography and biochemical study]

The purpose of this study was to correlate Doppler ultrasonographic parameters of fetal haemodynamic compromise with neonatal umbilical artery cardiacTroponin T [cTnT] level as a biochemical marker of fetal cardiac dysfunction in pregnancies complicated by preeclampsia [PE]].This study comprised 50 pregnant women, recruited within two years duration, from the antenatal care clinic and the high-risk pregnancy unit of Alnoor specialist hospital, Holy Makkah, KSA. Their gestational ages were ranging between 32-38 weeks and they were divided into: control group [20 women] with normal pregnancies [G] and study group [30 women], out of them 20 with PE without any ultrasonic Doppler detection of transmitted atrial pulsations to the intra-abdominal portion of fetal umbilical vein [GII] and 10 women with PE with ultrasonic Doppler detection of transmitted atrial pulsations, to the intra-abdominal portion of fetal umbilical vein [GIII]. For all cases routine ultrasound scanning, Doppler velocimetry [S/D ratio] for umbilical artery [UA] and for the intra abdominal portion of umbilical vein were done. Maternal cubital vein and neonatal UA serum troponin- T levels was measured. Cardiac troponin T concentrations showed high significant increase [P <0.01] in neonates who had transmitted atrial pulsations in fetal intra-abdominal part of umbilical vein, suggesting fetal myocardial cell damage, with the higher levels in fetuses with severe placental insufficiency, showing absent end-diastolic or reversed flow in UA. Maternal troponin T concentrations were within normal levels, even in cases in which neonatal troponin T levels were increased, which demonstrate that the umbilical artery troponin T measured in neonates was not of maternal origin.Doppler detectable transmitted atrial pulsations in the intraabdominal part of the umbilical vein is an ominous Doppler sign for fetal outcome in cases of PE associated with placental insufficiency, indicating fetal myocardial damage and mandates prompt delivery in hospital with well-equipped neonatal intensive care unit. The optimal timing of delivery in such cases should be before the appearance of this bad prognostic sign, depending on other Doppler parameters of fetal circulation

combination of middle cerebral to umbilical artery systolic/diastolic ratio and the modified biophysical profile in patients at risk for placental insufficiency

The aim of this study is to evaluate screening program using middle cerebral to umbilical artery systolic/diastolic ratio and the modified biophysical profile in the evaluation of group of patients at high risk for uteroplacental insufficiency. 50 patients were screened by modified biophysical profile and middle cerebral artery /umbilical artery systolic/diastolic ratio [20 without and 30 with intrauterine growth restriction]. The neonatal outcome was evaluated according to admission to the neonatal intensive care unit, the length of stay and the occurrence of significant neonatal complications [central nervous system complications, sepsis, acidosis, cardiomyopathy, anemia and metabolic] the incidence of significant neonatal complications was 10% and 30%, the length of stay in the neonatal intensive care unit was 3 and 3.2 +/- 1.3 days and the incidence of caesarean section due to fetal distress was 10% and 13.3% in both groups respectively. The positive predictive value of the Doppler ratio in the prediction of the neonatal outcome was 86.7%, 91.3% and the negative predictive value was 80%, 85.7 while the diagnostic accuracy was 85% 90% in groups respectively the middle cerebral artery to umbilical artery systolic/diastolic ratio is helpful in predicting the neonatal outcome especially in the growth restricted fetuses