Study of Triple Vessel Wave Pattern by Doppler Studies in Low Risk and High Risk Pregnancies and Perinatal Outcome
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 3
Abstract
Objectives:Role of Triple vessel umbilical, middle cerebral and uterine artery wave pattern by colour Doppler study in low and high risk pregnancies in relation to perinatal outcome. Methods:Fifty (50 )patients with gestational age between 31-40weeks who werediagnosed to have severe preeclampsia, preeclampsia with IUGR were studied andsubjected to colour Doppler ultrasonography. Findings of Doppler studies werecorrelated with the following adverse Perinatal outcomes; Perinatal deaths,Emergency CS for foetal distress, Low Apgar score (5 min Apgar <7), and admissionto NICU for complications of low birth weight. Pregnancy outcome was consideredto be Uneventful or Favourable when the above complications were absent.The uterine artery, Umbilical artery and the Middle cerebral artery Dopplerindices for the corresponding gestational age were compared with the referencevalues. The uterine artery and Umbilical artery Doppler indices were consideredabnormal if the value was above the 95th percentile of previously published values forgestational age. The Middle cerebral artery Doppler index was considered abnormal ifthe value was below the 5th percentile of previously published values for gestationalage. A single cut off value (1.08) was used for Cerebroplacental Ratio (MCA PI/UAPI), above which the cerebro placental ratio was considered normal and below whichit was considered abnormal. Results: Acceptable wave forms were obtained from Uterine artery, MCA and UA inall these cases. All the cases were followed up for the perinatal outcome.Cerebroplacental ratio had higher sensitivity (95%) and NPV (85%) than UAPI(Sensitivity 66.66%, NPV 79.40%) and MCA PI (Sensitivity 83.33% , NPV 77.27%) ,UAPI had higher specificity (93.10%) and PPV (87.5%) compared to cerebroplacentalration (Specificity 87%, PPV 88% ) and MCAPI (Specificity 85%, PPV 89.28%).Diagnostic accuracy of Cerebroplacental ratio (Accuracy=90%) was betterthan UAPI (Accuracy=82%) and MCA PI (Accuracy=84%) in predicting adverseoutcomes. Conclusion: In clinically diagnosed severe preeclampsia and suspected IUGR pregnancy,both Cerebroplacental ratio and Umbilical artery PI are strong predictors of adverseperinatal outcome. Cerebroplacental ratio is most sensitive and Umbilical artery PI ismost specific index in predicting adverse outcome. Absent or reversed end diastolicflow in an umbilical artery is an ominous finding associated with major adverseperinatal outcome and mortality.
Authors and Affiliations
Sureendhar Mohan, Paarthipan Natarajan, Sandeep Madineni, Rajasekhar K. V.
Keywords
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- DOI 10.9790/0853-1603061423
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