Fetal Doppler Indices in Predicting Perinatal Outcome Among Severely Hypertensive Pregnant Patients.
Condition: Pre-Eclampsia; IUGR
MeSH terms: Eclampsia; Pre-Eclampsia
Study type: Observational

Summary: 
      60 pregnant women with singleton living fetus between 34 -38 wks gestation known to have
      severe hypertension in the current pregnancy were included.

      All participants underwent Doppler ultrasonography to evaluate the Feto-Placental Circulation
      within 24 hours from Pregnancy Termination.

      Flow Velocity Waveforms were obtained from: Umbilical Artery (UA), Middle Cerebral Artery
      (MCA), Ductus Venosus (DV), Umbilical Vein (UV).

      From the flow velocity waveforms the following indices were measured:

      UA & MCA: Pulsatility Index (PI) & Resistance Index (RI), DV: Peak Velocity Index For veins
      (PVIV), Peak Systolic Velocity (PSV) & a- wave.

      UV Flow: Presence or Absence of Pulsatile Flow.
    

Detailed description: 
      60 pregnant women (aged from 18- 35 years) with singleton healthy living fetus between 34 -38
      wks gestation known to have severe hypertension in the current pregnancy were included.

      Chronic Hypertension was defined as a blood pressure value of 140/90 mm Hg or higher
      diagnosed before 20 weeks' gestation or preconception. Gestational Hypertension was defined
      as blood pressure value of 140/90 mm Hg or higher on 2 occasions at least 4 hours apart that
      occurred after 20 weeks' gestation in a patient with previously normal blood pressure.
      Preeclampsia was defined as blood pressure value of 140/90 mm Hg or higher on 2 occasions at
      least 4 hours apart and proteinuria (Proteinuria is defined as the excretion of 300mg or more
      of protein in a 24 hour urine collection or 1+ by The dipstick method) that occurred after 20
      weeks' gestation in a patient with previously normal blood pressure. Chronic hypertension &
      gestational hypertension was considered to be severe if systolic blood pressure ≥160 mmHg or
      diastolic blood pressure ≥110 mmHg, or both & persists for 15 minutes or more. Preeclampsia
      was considered to be severe in the following conditions: Blood pressure of 160/110 or more,
      Thrombocytopenia (platelet count less than 1000,000 / microliter), impaired liver function
      (elevated blood levels of liver transaminases to twice the normal concentration) , severe
      persistent right upper quadrant or epigastric pain unresponsive to medication and not
      accounted for by alternative diagnosis, or both, the new development of renal insufficiency
      (elevated serum creatinine > 1.1mg/dL or a doubling of serum creatinine in the absence of
      other renal disease) & new-onset cerebral or visual disturbances. Patients with other
      maternal medical disorders rather than hypertension or experienced rupture of membrane or
      antepartum hemorrhage (placenta previa or accidental hemorrhage) were excluded. Also,
      patients who received respiratory depressants medications within 2 hours from the delivery of
      the fetus (e. g., opioid analgesic) were excluded.

      Informed consents were obtained from all participants after explanation of the study and its
      aims. All participants underwent the following: Full history taking including a detailed
      history of the hypertension state during the current pregnancy (onset, course, current
      medication, and whether the blood pressure is controlled or not). complete physical
      examination: general (including BMI & blood pressure measurement) and obstetric examinations.
      Routine obstetric ultrasound: to confirm gestational age & fetal viability & number, assess
      fetal weight (EFW) and growth percentile & amniotic fluid index (AFI) & to exclude fetal
      anomalies. Laboratory investigations (Complete blood count (CBC) - Urine analysis for
      albuminuria - Liver enzymes & kidney function). In addition to Doppler ultrasonography
      assessment using GE Voluson Pro-V and GE Voluson E10 with 3.5-5 MHz abdominal transducer).
      The color flow imaging (to identify the vessels) & pulsed wave velocimetry was used to obtain
      flow velocity waveforms within 24 hours of pregnancy termination from: Umbilical artery (UA):
      from a free-floating loop in the mid portion of the cord, Middle cerebral artery (MCA):
      obtained from a transverse image of the fetal head at the level of sphenoid bones (color flow
      im¬aging was used to display the circle of Willis), Ductus venosus (DV) was sampled soon
      after its origin from the umbilical vein & finally Umbilical vein flow (UV) assessment. In
      all Doppler studies, while the woman is lying in a semi-recumbent position, the angle of
      insonation of the vessels is < 45 degrees & the high-pass filter is set at 100 Hz. Care is
      taken not to exert undue pressure on the fetal head because this alters the flow velocity
      waveforms from the MCA. Furthermore, examination of the fetal vessels was performed in the
      absence of fetal body and respiratory movements, with a fetal heart rate ranging from 120-160
      bpm. Measurements was obtained from ≥ 4 consecutive flow velocity waveforms of good quality
      and averaged. From the flow velocity waveforms of the UA & MCA, the pulsatility index (PI) &
      the resistance index (RI) was measured. From the flow velocity waveforms of the DV, peak
      velocity index (PVIV), peak systolic velocity (PSV) and A wave was measured. From the
      umbilical vein flow, the presence or absence of pulsatile flow was recorded. All labours was
      attended by an expert neonatologist who was blinded to the results of Doppler indices
      measurements & the following was recorded: APGAR score at (1 & 5 min) - Neonatal birth weight
      (Fetal growth restriction will defined as birth weight of less than 10th percentile of
      newborn weight in normal pregnancies at corresponding gestational age) - the occurrence of
      respiratory complications [Transient Tachypnea of the newborn (TTN) or Respiratory Distress
      Syndrome (RDS)] - The further need for neonatal intensive care unit (NICU) admission &
      Perinatal death.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        60 pregnant women with singleton living fetus between 34 -38 wks gestation known to have
        severe hypertension in the current pregnancy were included.
      
Keywords: PREECLAMPSIA; DOPPLER; IUGR; UMBILICAL ARTERY; MIDDLE CEREBRAL ARTERY