Study on Uterine Artery Doppler: Screening Tests in Hypertesive Disorders Of Pregnancy
Keywords:
Uterine artery Doppler, Pre eclampsia, Gestational hypertension
Abstract
OBJECTIVES: To Study and analyse uterine artery Doppler Resistance index as predictor of Hypertensive disorders in pregnancy at 18 to 22 weeks METHODS A Longitudinal Prospective observational Study was done on 274 antenatal mothers attending the outpatient department of Obstetrics & Gynaecology, Rangaraya Medical College, Kakinada from January 2015 to October 2016 in 18 -35 yrs with inclusion criteria.Uterine artery Doppler resistance index (0.58 taken as cut-off) was recorded at 18 -22weeks of gestation. Appropriate statistical tests were performed using SPSS software version 17. Sensitivity, specificity, positive and negative predictive value of the tests was calculated were followed up till term for development of pre-eclampsiaRESULTS The incidence of hypertensive disorders detected in positive Doppler screening was16.2% (n= 44) where as 83.8 % (n = 230) of the study subjects were not hypertensive. Majority of the cases (67%) were found to have Mild preeclampsia (n =29) followed by severe preeclampsia in 17 % of cases (n = 7) and 8% of cases developed eclampsia and also 8% developed gestational hypertension (n = 4). 217 (79.2%) of the study participants were found to be having RI ≤ 0.58. Uterine artery Resistance Index as a predictor of hypertension has a sensitivity of 88.64% specificity of 92.17% positive predictive value of 68.42%, negative predictive value of 97.7% and diagnostic accuracy was 91.6%, this association is also found to be significant [p = 0.000 ( < 0.05)].CONCLUSION The present study concluded uterine artery resistance index as a better test in prediction of hypertension in pregnancy to prevent or reduce maternal as well as perinatal morbidity and mortality. DOI: 10.21276/awch.2017.1241References
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17. Maulik D, Doppler Ultrasound in Obstetrics and Gynecology 2nd Revised and Enlarged Edition
18. Bhattacharyya Sanjoy Kumar, Kundu Sarmila, Kabiraj Sankar . Prasad Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women. The Journal of Obstetrics and Gynecology of India (May-June 2012) 62(3):297-300
19. Padmalatha VV, Rao PSS, Susan Abraham, Asha Thomas. Predicting Pre-Eclampsia & Fetal Growth Restriction through Second Trimester Uterine Artery Doppler Sonography: An Indian experience IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 12, Issue 1 (Nov.- Dec. 2013), PP 21-26
20. CA Meads, JS Cnossen, S Meher, A Juarez-Garcia, G ter Riet, L Duley, TE Roberts, BW Mol, JA van der Post, MM Leeflang, PM Barton, CJ Hyde, JK Gupta and KS Khan .Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modeling. Health Technology Assessment 2008; Vol. 12: No. 6
21. Kanwal Gujral, Sakshi Nayar. Prediction of Pre-eclampsia. J. Fetal Med. (June 2016) 3:55–61
22. Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of preeclampsia and intrauterine growth retardation. Br J Obstet Gynaecol 1993;100:
2.Manjusha Sajith, Vandana Nimbargi, Amit Modi, Ronak Sumariya, Atmaram Pawar. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. International journal of pharma sciences and research (ijpsr) vol 5 no 04 apr 2014.
3. Kuklina EV, et al. Hypertensive Disorders and Severe Obstetric Morbidity in the United States. Obstet Gynecol 2009; 113:1299-306.
4. Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division
5. Ekholm E. Hemodynamic measures in prediction of pre-eclampsia. Acta Obstet Gynecol Scand 1997; 76: 101-103.
6. Grunewald C. Biochemical prediction of pre-eclampsia..Acta Obstet Gynecol Scand 1997 (Suppl 164);76:104- 107.
7. Walsh SW. Pre-eclampsia: an imbalance in placental prostacycline and thromboxane production. Am J Obstet Gynecol 1985;152:335-340
8. Gupta Shashi, Gupta Pradeep Kumar, Bodani Preeti ,Khamsera Anshu.Transvaginal doppler of uteroplacental circulation in early prediction of pre-eclampsia by observing bilateral uterine artery notch and resistance index at 12-16 weeks of gestation. J obset gynecol India 2009;59(6):541-546
9. Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM: Births: Final data for 1998. National Vital statistics reports: Hyattsville, MD. National center Health Statistics, 2000:48
10. Montan S.Sjoberg O-O. Svenningsen. N. Hypertension in pregnancy—fetal and infant outcome. Clin Exp Hypertens –Hyper in Pregnancy 1987; B62: 337-348
11. GreggoryR.Devore. Fetal diagnostic centres 1st trimester screening. http://www.fetal.com/NT%20Screening/10%20Uterine%20Artery%20Meas.html
12. Eclampsia registry the incidence of hypertensive disorders in India Journal of obstetrics & gynecology of India vol 64 Jan – Feb 2014.
13. Lim KH, Zhou Y, Janatpour M, McMaster M, Bass K, Chun SH, Fisher SJ: Human cytotrophoblast differentiation/invasion is abnormal in pre-eclampsia. Am J Pathol 151: 1809– 1818, 1997
14. Bakht R., Nikkhoo N., Aghababaei S. Assessing roll-over test in early diagnosis of preeclampsia. The Journal of Qazvin University of Medical Sciences, Fall 2004 , Volume Number 32
15. Low JA. The current status of maternal and fetal blood flow velocimetry. Am J Obstet Gynecol 1991;164:1049.
16. Katie MG, Robyn A, North, Peter RS, Eliza H.Y.Chan, Rennae S. Taylor, Gustaaf A.Dekker.et,al. Patterns Of change in uterine artery doppler studies between 20 and 24 weeks of gestation and pregnancy outcome. The American college of obsteticians and Gynoecologist published 2009;113(2)332-338.
17. Maulik D, Doppler Ultrasound in Obstetrics and Gynecology 2nd Revised and Enlarged Edition
18. Bhattacharyya Sanjoy Kumar, Kundu Sarmila, Kabiraj Sankar . Prasad Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women. The Journal of Obstetrics and Gynecology of India (May-June 2012) 62(3):297-300
19. Padmalatha VV, Rao PSS, Susan Abraham, Asha Thomas. Predicting Pre-Eclampsia & Fetal Growth Restriction through Second Trimester Uterine Artery Doppler Sonography: An Indian experience IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 12, Issue 1 (Nov.- Dec. 2013), PP 21-26
20. CA Meads, JS Cnossen, S Meher, A Juarez-Garcia, G ter Riet, L Duley, TE Roberts, BW Mol, JA van der Post, MM Leeflang, PM Barton, CJ Hyde, JK Gupta and KS Khan .Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modeling. Health Technology Assessment 2008; Vol. 12: No. 6
21. Kanwal Gujral, Sakshi Nayar. Prediction of Pre-eclampsia. J. Fetal Med. (June 2016) 3:55–61
22. Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of preeclampsia and intrauterine growth retardation. Br J Obstet Gynaecol 1993;100:
Published
2017-01-21
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