Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women.

Background and objective Pre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women. Methodology This was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery's flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria. Results Twenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE. Conclusion Abnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Fetomaternal Outcome Among the Pregnant Women Subject to the Induction of Labor.

Introduction Induction of labor (IOL) is characterized by stimulating contractions of the uterus just before the instantaneous onset of labor, with or without amniotomy. According to the recommendation of the World Health Organization (WHO), induction must only be carried out when there is a clear medical need for one and when potential benefits outweigh the expected harm that may be caused by it. The present study was to determine the frequency of fetomaternal outcomes among pregnant women subject to the induction of labor. Methods The present prospective cross-sectional study was conducted over a period of one year starting from June 17, 2018, to July 25, 2019, in the Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi. After institutional ethical committee approval, 302 pregnant women who were subject to induction of labor were enrolled using a non-probability consecutive sampling technique. Outcome variables, i.e., postpartum hemorrhage, mode of delivery, hospital stay more than seven days, birth asphyxia, Apgar score < 7 at five minutes, neonatal jaundice, and low birth weight were noted. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY) was used for data analysis. Results A total of 302 women with an average age range was 18-45 years with a mean age of 28.5 ± 4.47, body mass index (BMI) 29.83 ± 3.83, and mean gestational age was 37 ± 4.3. Almost 205 (67.9%) of the cases were booked. One hundred and eighty (59.6%) were nulliparas, 57(18.8%) had para-1, 43 (14.4%) had para-2, and 22 (7.14%) had par-3. When fetomaternal outcome among the pregnant women subject to induction of labor was observed, postpartum hemorrhage was observed in 55 (18.21%), hospital stay more than seven days was in 51 (17%), birth asphyxia was in 45 (14.9%), neonatal jaundice was in 53 (17.6%), low birth weight was in 15 (4.96%), Apgar score < 7 was in 48 (16%), 39 (13%) women underwent for C-section and 263 (87%) of the women delivered vaginally. Conclusion This study concludes that the induction of labor (IOL) is safe and reliable and less risk of adverse feto-maternal outcome is associated with pregnancies between 37 weeks and 42 weeks of gestation. The evidence regarding IOL prior to 37 weeks and beyond 42 weeks of gestation is inadequate to reach any conclusion.

Relationship Between Cervical Dilatation At Which Women Present In Labor And Subsequent Rate Of Caesarian Section.

BACKGROUND: Increasing rate of caesarean section is becoming an epidemic worldwide. This study was conducted to compare rate of caesarean section between women presenting in labor with cervical dilatation less than 4 cm to those with cervical dilatation 4 cm or more. METHODS: This study was conducted at Aga Khan Hospital for Women, Karimabad. Women with singleton pregnancy and cephalic presentation at term in spontaneous labour were included. Patients were divided in two groups: early presenters with cervical dilatation less than 4 cm and late presenters with cervical dilatation of 4 cm or more. Primary outcome measured was rate of caesarean section, while secondary outcomes were duration of labour, APGAR score and any neonatal complication. RESULTS: Medical records of 442 women were reviewed. Difference in mean age of women presenting early in labour was of 2 years (26.8±4.7 vs 28.4±4.5) which was significant (p-value 0.01). More than two thirds of primiparas presented early (69.0% vs 31%) in labour and early presenters had longer labour (p-value <0.001). 62% of early presenters had artificial rupture of membrane compared to 41% of late presenters and nearly 73% required analgesia (p-value <0.001). Caesarean section rate was 10.5% in early and 1.8% in late presenters that was significant (p-value <0.001). APGAR score of both groups was comparable. CONCLUSIONS: Integrated midwifery services and antenatal classes may help in education of labouring women and their understanding of labour process and so that low risk women can be monitored at home and come to hospital in active labour.