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A prospective study of role of color Doppler in high-risk pregnancies in a tertiary care hospital

Dhara Shah, Chinmay Shah, Mona Shastri, Ekta Desai, Dhagash Patel, Mona Chitara.




Abstract

Background: High-risk pregnancies are associated with many adverse perinatal outcomes. The use of Doppler ultrasound offers a non-invasive way to study the fetal and maternal circulation and guide the clinical management.

Objective: The aim of this study is to evaluate the role of color Doppler in the effective management of high-risk pregnancies.

Materials and Methods: This was a prospective and observational study carried out for 2 years in the Department of Radiology with the help of the Department of Obstetrics and Gynecology. Antenatal women in the age group of 20-30 years with singleton pregnancy of gestational age of 26 weeks to term and presence of one of the high-risk factors were enrolled in the study. The risk factors considered were pregnancy-induced hypertension (PIH), diabetes, anemia, oligohydramnios, toxoplasmosis, and hepatitis. Doppler study of umbilical artery, fetal middle cerebral artery (MCA), and both the maternal uterine arteries was done. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. Details of obstetric history and delivery were taken. Patients were followed up at regular intervals.

Results: A total of 110 cases were enrolled in the study. High-risk pregnancy was more common in the age group of 20-25 years. The most common high-risk factor in pregnancy was PIH which accounted for 49% of cases. Out of 110 high-risk pregnancies, 39% (n = 43) of cases resulted in intrauterine growth restriction (IUGR). PIH, anemia, and diabetes were more associated with IUGR as compared to oligohydramnios, hepatitis, and toxoplasmosis. Out of 110 high-risk cases, in 43% (n = 47) cases, umbilical artery findings were abnormal. 38% of cases of isolated fetoplacental insufficiency without uteroplacental insufficiency were more associated with intrauterine death. Isolated umbilical artery abnormality was more associated with adverse perinatal outcomes (72%) than isolated MCA abnormality. Survivability of fetus increased when early induction or lower (uterine) segment caesarian section was done on emergency basis.

Conclusion: Doppler can be used as a reliable tool for fetal surveillance in high-risk pregnancy cases. It helps in guiding early intervention and improving fetal outcome.

Key words: Doppler Ultrasound; Gestational Hypertension; High-risk Pregnancy; Perinatal Outcome






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