Role of doppler ultrasonography in prediction of adverse perinatal outcome in intrauterine growth retardation (IUGR)

Introduction: A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome - Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation. Materials and methods: A total of 172 singleton pregnancies between 33 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Duration of this study was two years, from December 2019 to November 2021. Results: Out of 172 cases, 146 were live born and 26 were neonatal death. There were 7 cases of intrauterine death of fetuses and 5 were still born. Out of the live born 27 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia. Conclusion: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse fetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised fetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised fetuses and helps to determine the optimal time of delivery.

Evaluation of perinatal outcome in high-risk pregnancy at tertiary care centre

Background: A high risk pregnancy is one in which mother, fetus or neonate is at increased risk of morbidity or mortality before or after delivery. Hence a relatively small percentage of high risk obstetric population gives rise to a disproportionately high percentage of perinatal and maternal morbidity and mortality. The perinatal outcome can be changed significantly by early detection and special intensive care to high risk pregnancies. Hence Identification of women at risk for these complicated pregnancies with poor outcome is fundamental to antenatal check-up.Methods: 86 high risk antenatal patients attending the outpatient department and labour room were recruited after informed consent.70 normal pregnancy was taken as control group. Perinatal outcomes were compared between high risk and normal pregnancies.Results: Adverse perinatal outcomes were more in high risk pregnancies as compared to normal pregnancies.Conclusions: This study emphasizes on pregnancy related complication leading to adverse perinatal outcome so evaluating patients for high risk factors, early diagnosis, proper antenatal care, prompt treatment, regular follow up, and timely management thus can improve maternal and perinatal outcome.

Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births / Resultados perinatais adversos em mulheres com idade materna avançada: estudo transversal com nascimentos brasileiros

ABSTRACT OBJECTIVES: To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS: Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS: For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years), and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births), of low Apgar score at 5 min (for term births), of macrosomia (for non-primiparous women), and of asphyxia. CONCLUSION: As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.

RESUMO OBJETIVOS: Investigar o risco de resultados perinatais adversos em mulheres ≥ 41 anos relativamente àquelas com idade 21-34. MÉTODOS: Cerca de 8,5 milhões de registros de nascimentos únicos em hospitais brasileiros no período 2004-2009 foram investigados. Odds ratios foram estimados para nascimentos prematuros e pós-termo, baixos índices de Apgar no 1° e 5° minutos, asfixia, baixo peso ao nascer e macrossomia. RESULTADOS: Para as mulheres grávidas ≥ 41, aumento de riscos foram identificados para nascimentos prematuros, partos pós-termo (com exceção de primíparas com escolaridade ≥ 12 anos) e baixo peso ao nascer. Relativamente a mulheres mais velhas vs. mais jovens, maiores níveis de escolaridade garantem riscos semelhantes de baixo índice de Apgar no 1° minuto (para primíparas e nascimentos a termo), de baixo índice de Apgar no 5° minuto (para nascimentos a termo), de macrossomia (para não primíparas) e de asfixia. CONCLUSÃO: Em geral, mães mais velhas estão sob maiores riscos de desfechos perinatais adversos, mas esses são minimizados ou eliminados a depender da idade gestacional, da paridade e, em especial, da escolaridade da gestante.

Prediction of adverse perinatal outcome by umbilical artery to middle cerebral artery resistance index ratio in pregnancies complicated by hypertensive disorder.

This study aimed to evaluate umbilical artery to middle cerebral artery resistance index ratio above 95th percentile (UARI / MCARI 95) was able to predict adverse perinatal outcome in pregnancies complicated by hypertensive disorder. Fitty-three pregnant women with hypertensive disorder were recruited to this study. All of these women gave birth within 7 days of performing the Doppler study. The ability of UARI / MCARI 95 to predict adverse perinatal outcome was as follow: sensitivity 12.5%, specificity 89.2%, positive predictive value 33.3%, negative predictive value 70.2%, false positive rate 10.8%, false negative rate 87.5% and accuracy 66%. This ratio did not qualify as a reliable screening test for prediction of adverse perinatal outcome prediction in pregnancies complicated by hypertensive disorder.

Perinatal Outcome, Prevalence and Clinical Significance of Pregnancies with Single Umbilical Artery / 대한산부인과학회잡지

No abstract available.