DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170974

The role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension

Nehal S. Diwanji, Alpesh D. Pancholi, Mona Shastri

Abstract


Background: Nearly one third intrauterine death of normally formed singleton fetuses are associated with IUGR coexisting with or without pregnancy induced hypertension (PIH). Abnormal fetal circulation is considered a major factor in fetal growth restriction, both as a cause and an indicator. Doppler ultrasound is a relatively new technique which merits investigations as a screening method for IUGR and PIH as both are associated with placental vascular pathology. The development of Doppler ultrasonographic technology, particularly during last 10 years, has provided an opportunity to obtain both qualitative and quantitative assessment of maternal and fetal hemodynamics using a non-invasive method. Objectives were to assess the role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension.

Methods: It was a prospective observational study in which 50 pregnant women were taken as cases with pregnancy induced hypertension and 25 as matched controls without any high-risk factor. All patients were examined for colour Doppler spectral flow analysis. Detailed USG results in the form of maturity by biparietal diameter, head circumference, femoral length, abdominal circumference, liquor, and expected fetal weight were measured and noted. Doppler study of umbilical artery, fetal middle cerebral artery, both maternal uterine arteries and ductus venosus was carried out. Parameters in the form of resistive index (RI), pulsatility index (PI) and systolic/diastolic ratio (S/D) of all four arteries were taken. In ductus venosus waveform, changes in the ‘a’ wave were noted. All participants were followed up from the point of the recruitment up to the time of delivery. At the time of delivery, the mode of delivery, any complications, the Apgar score, weight of the baby, birth asphyxia and admission in NICU were noted.

Results: The number of patients with PIH were highest in the age group of 21-25 years [n=31 (62%)]. IUGR of fetus occurred in 74% of the cases with PIH, while no any patients with IUGR fetus among the control group. 92% patients among uterine notches showed abnormal fetal outcome in the form of low birth weight, preterm delivery, LSCS for fetal distress, birth asphyxia or NICU admission of the neonate. Out of total 37 (74%) IUGR cases, 24 (65%) cases had fetoplacental Doppler abnormality. Out of total 6 cases with absent end-diastolic flow (AEDF) 4 cases had abnormal fetal outcome and 2 cases had delivered still-born babies. 20 out of 30 cases had abnormal fetal middle cerebral arterial Doppler (MCA) PI, out of which 19 patients had abnormal fetal outcome. 23 cases had abnormal CPR, out of them 20 (87%) cases had abnormal outcome and only 3 cases had normal fetal outcome. The parameters at the time of delivery are number of cases with delivery before 37 weeks of GA (63.3%), SGA babies (70%), LSCS for fetal distress (43.3%), and NICU admission (43.3%).

Conclusions: Examining the maternal vessels using Doppler ultrasound, it is possible to determine the risk of complication developing in the course of pregnancy long before clinical signs of preeclampsia appear, so that therapeutic measures may be undertaken early.


Keywords


Color Doppler examination, Pregnancy induced hypertension, Spectral flow analysis, Umbilical artery, Uterine artery

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References


Trudinger BJ. The principles and practice of ultrasonography. In: Obstetrics and Gynecology. 4th edition; Obstetric Doppler application; 2012:173.

Kingston. The current status of maternal and fetal blood flow velocimetry. Ultrasound panel. Am J Obstet Soc. 1991;164(4):1049-63.

Kevin A, Mairi H, James P, Martin J. Pregnancy screening by Doppler uteroplacental and umbilical artery waveforms. Br J Obstet Gynecol. 1989;96:1163-7.

Berkowitz GS, Chitkara U, Rosenberg J, Cogwell C. Sonographic estimation of fetal weight and Doppler intrauterine growth retardation- a prospective study. Am J Obstet Gynecol. 1988;158:1149-53.

Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Am J Obstet Gynecol. 1988;158(1):80-3.

CJ Bhatt. Role of color Doppler in PIH-study of 100 cases. Indian J Radiol Imag. 2003;13(4):417-20.

Farmakides G, Schulman H, Schneider E. Surveillance of the pregnant hypertensive patient with Doppler flow velocimetry. Clin Obstet Gynaec. 1992;35:387-94.

Bhushan NL, Shafeek AA. Doppler velocimetry of uterine and umbilical arteries during pregnancy. Indian J Radiol Imag. 1999;9(3):119-25.

Ghazali WAL, Chapman MG. The role of Doppler velocimetry in the management of high risk pregnancies; Br J Obstet Gynecol. 1994;101:114-20.

Trudinger. Umbilical artery velocity wave form in the intrauterine growth retarded fetus: Clin Obstet Gynecol. 1989;32(4):664.

Adamson SL. Arterial pressure, vascular input impedance and resistance as determinants of pulsatile blood flow in the umbilical artery. Eur J Obstet Gynecol Reprod Biol. 1999;84:119-25.

Ott WJ. Intrauterine growth restriction and Doppler ultrasonography. J Ultrasound Med. 2000;19:661-5.

McCowan LM, Harding JE, Stewart AW. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. Br J Obstet Gynecol. 2000;107:916-25.

Yoon BH, Syn HC, Kim SW. The efficacy of Doppler umbilical artery velocimetry in identifying fetal acidosis. A comparison with fetal biophysical profile. J Ultrasound Med 1992;11:1-6.

Ferrazzi E, Vegni C, Bellotti M, Borboni A, Della PS, Barbera A. Role of umbilical Doppler velocimetry in the biophysical assessment of the growth-retarded fetus. Answers from neonatal morbidity and mortality. J Ultrasound Med. 1991;10:309-15.

Rochelson B. The clinical significance of absent end diastolic velocity in the umbilical artery waveforms, Clin Obstet Gynecol. 1989;32(4):692.

Bahado-Singh RO, Kovanci E, Jeffres A. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol. 1999;180:750-6.

Arbeille P, Maulik D, Fignon A. Assessment of the fetal pO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia. Ultrasound Med Biol. 1995;21:861-70.

Sterne G, Shields LE, Dubinsky TJ. Abnormal fetal cerebral and umbilical Doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity. J Clin Ultrasound. 2001;29:146-51.

Makhseed M, Jirous J, Ahmed MA, Viswanathan DL. Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome. Int J Gynaecol Obstet. 2000;71:119-25.

Hecher K, Campbell S, Doyle P, Harrington K, Nicolaides K. Assessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation. Circulation. 1995;91:129-38.

Ozcan T, Sbracia M, d'Ancona RL, Copel JA, Mari G. Arterial and venous Doppler velocimetry in the severely growth-restricted fetus and associations with adverse perinatal outcome. Ultrasound Obstet Gynecol. 1998;12:39-44.

Arora D, Desai SK, Sheth PN, Kania P. Significance of umbilical artery velocimetry in perinatal outcome of growth restricted fetuses. J Obstet Gynecol India. 2005;55(2):138-43.

Hata T, Senoh D, Hata K, Kitao M. Ophthalmic artery velocimetry in preeclampsia. Gynecol Obstet Invest. 1995;40:32-5.

Hata T, Hata K, Moritake K. Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancy and pregnancy complicated by hypertensive disorders. Am J Obstet Gynecol. 1997;177:174-8.