Is double-blinding possible while administering fluids in the intensive care unit? : letter to the editor (original) (raw)
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Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome. Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out. Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates. Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.
Bjog-an International Journal of Obstetrics and Gynaecology, 2000
Objective To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre-eclampsia and its associated complications of intrauterine growth retardation and perinatal death.Design Quantitative systematic review of observational diagnostic studies using online searching of the MEDLINE database coupled with scanning of the bibliographies of primary and review articles including known unpublished studies.Material Twenty-seven studies involving 12,994 subjects stratified into population subgroups at low and high risk of developing pre-eclampsia and its complications.Outcome measures The outcome measures studied were: 1. the development of pre-eclampsia; 2. intrauterine growth retardation; and 3. perinatal death. The main meta-analyses were the flow velocity waveform ratio ± diastolic notch derived by transabdominal Doppler ultrasound as the measurement parameter. The analyses were conducted using likelihood ratio as a measure of diagnostic accuracy. A likelihood ratio of 1 indicates that the test has no predictive value for the outcome. Prediction for the outcome event is considered conclusive with likelihood ratios of > 10 or < 0.1 for a positive and negative test result, respectively. Moderate prediction can be achieved with likelihood ratios of 5–10 and 0.1–0.2 whereas likelihood ratios values of 1–5 and 0.2–1 would generate only minimal prediction.Results In the low risk population a positive test result, predicted pre-eclampsia with a pooled likelihood ratio of 6.4 (95% CI 5.7–7.1), while a negative test result had a pooled likelihood ratio of 0.7 (95% CI 0.6–0.8). For intrauterine growth retardation the pooled likelihood ratio was 3.6 (95% CI 3.2–4.0) for a positive test result and 0.8 (95% CI 0.8–0.9) for a negative test result. Using perinatal death as outcome measure, the pooled likelihood ratio was 1.8 (95% CI 1.2–2.9) for a positive test result and 0.9 (95% CI 0.8–1.1) for a negative test result. In the high risk population a positive test result predicted pre-eclampsia with a pooled likelihood ratio of 2.8 (95% CI 2.3–3.4), while a negative test had a likelihood ratio of 0.8 (95% CI 0.7–0.9). For intrauterine growth retardation the pooled likelihood ratio was 2.7 (95% CI 2.1–3.4) for a positive test result and 0.7 (95% CI 0.6–0.9) for a negative result. For perinatal death the pooled likelihood ratio was 4.0 (95% CI 2.4–6.6) for a positive test result and 0.6 (95% CI 0.4–0.9) for a negative result.Conclusion Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting preeclampsia, intrauterine growth retardation and perinatal death.
Ultrasound in Obstetrics and Gynecology, 2001
Objective To determine the value of transvaginal color Doppler assessment of the uterine arteries at 23 weeks of gestation in predicting the subsequent development of pre-eclampsia and fetal growth restriction. Patients and methods Women with singleton pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility index of the two arteries was calculated. Screening characteristics in the prediction of pre-eclampsia and the delivery of a low birth-weight infant were calculated. Results Doppler examination of the uterine arteries was attempted in 8335 consecutive singleton pregnancies, satisfactory waveforms were obtained from both vessels in 8202 (98.4%) cases and complete outcome data were available in 7851 (95.7%) of these. The mean gestational age was 23 (range, 22-24) weeks. The mean uterine artery pulsatility index did not change significantly with gestation (r =-0.0078; P = 0.483); the median value was 1.04 and the 95th centile was 1.63. In 9.3% of cases early diastolic notches in the waveform from both uterine arteries were present and in an additional 11.1% of cases there were notches unilaterally. Pre-eclampsia with fetal growth restriction occurred in 42 (0.5%) cases, pre-eclampsia without fetal growth restriction in 71 (0.9%) and fetal growth restriction without pre-eclampsia in 698 (8.9%). The sensitivity of increased pulsatility index above the 95th centile (1.63) for pre-eclampsia with fetal growth restriction was 69%, for pre-eclampsia without fetal growth restriction was 24%, for fetal growth restriction without pre-eclampsia was 13%, for pre-eclampsia irrespective of fetal growth restriction was 41% and for fetal growth restriction irrespective of pre-eclampsia was 16%. The sensitivity of fetal growth restriction defined by the 5th rather than the 10th centile was higher (19% vs. 16%). The sensitivity for both pre-eclampsia and fetal growth restriction was inversely related to the gestational age at delivery; when delivery occurred before 32 weeks, the sensitivity for all cases of pre-eclampsia with fetal growth restriction, pre-eclampsia without fetal growth restriction and fetal growth restriction without pre-eclampsia increased to 93%, 80% and 56%, respectively. The sensitivity of bilateral notches in predicting pre-eclampsia and/or fetal growth restriction was similar to that of increased pulsatility index but the screen-positive rate with notches (9.3%) was much higher than that with increased pulsatility index (5.1%). Conclusions A one-stage color Doppler screening program at 23 weeks identifies most women who subsequently develop severe pre-eclampsia and/or fetal growth restriction.
Ultrasound Doppler evaluation of uteroplacental and fetoplacental circulation in pre-eclampsia
Archives of Gynecology and Obstetrics, 1988
Blood flow velocity waveforms (FVW) were recorded weekly from the umbilical and arcuate arteries in 58 hospitalised women with a pregnancy complicated by pre-eclampsia. The maximum velocity waveform was analysed for pulsatility index (PI) and the results from the final antenatal examination were related to the outcome of pregnancy. The umbilical artery FVW was abnormal in 36% of the pre-eclamptic pregnancies, as was the arcuate artery FVW in 42%. No difference in FVW was found between mild and severe pre-eclampsia. Abnormal FVW in the umbilical artery was associated significantly both with intra-uterine growth retardation (IUGR) (P < 0.001) and with signs of fetal distress (FD) (P < 0.05). Abnormal arcuate artery FVW was associated with FD (P < 0.05), but not with IUGR. The outcome of pregnancy was related to Placenta Waveform Class, which was derived from the blood velocity on both maternal and fetal sides of placenta. The results suggest that ultrasound Doppler examination of the umbilical artery is a useful aid in monitoring pregnancies complicated by preeclampsia, but that arcuate artery examination needs further evaluation.
Relationship between preeclampsia umbilical blood flow and perinatal outcome
Background: Doppler indices of the umbilical artery are used as indicator of fetal well being that permit early detection of fetal compromise and avoid delaying in the management. Study design: A prospective multiple logistic regression analysis studies. Objective: To compare Doppler parameters of umbilical artery including pulsatility index (PI) and resistance index (RI) and systolic diastolic ratio [S/D] in patients suffering from preeclampsia with those having normal pregnancies and to evaluate the diagnostic characteristics of these parameters in fetal outcome. Materials and Methods: One hundred singleton pre-eclamptic women at their term (50 with mild & 50 with severe preeclampsia) and 50 women with normal pregnancy were included in the study & subjected to doppler study of the umbilical artery where resistance index , pulsatility index & systolic diastolic ratio were measured using doppler ultrasound (Acuson x3oo) at Al-Elwiya Maternity Teaching Hospital during the period from May 2013 to July 2014. Fetal outcome (fetal weight, Apgar score and Neonatal Care Unit admission NCU) were compared in the two groups and diagnostic characteristics of the Doppler indices were determined. The data are arranged on questionnaire papers and then subjected to statistical analysis. Results: Mean of pulsatility index (1.32), resistance index (0.77) and systolic diastolic ratio (3.38) in preeclamptic patients were significantly higher than normal group (PI 0.97, RI 0.64&S\D ratio 2.68), elevated Doppler indices were found to be associated with worse fetal outcome (low birth weight, Apgar score and higher NCU admission). Besides, those with severe preeclampsia showed significantly higher values of (PI 1.52, RI 0.83& S\D ratio 3.86) compared to those with mild preeclampsia (PI 1.24, RI 0.74 & S\D ratio 2.90). For PI, the cutoff of ≥0.98 yielded the highest sensitivity and specificity. Also, RI of 0.64 acquired a sensitivity of 100% and specificity of 44% and same result for S/D ratio. Conclusion: Umbilical artery pulsatility index, resistance index and S/D ratio increase in preeclampsia and these changes tend to be greater in severe preeclampsia and with worse fetal outcome (low birth weight, Apgar score and higher NCU admission) the cutoff values were 0.98 for PI and/or 0.64 for RI.
The role of umbilical artery doppler indices in predicting perinatal outcome in preeclampsia
International Journal of Research in Medical Sciences
Background: Preeclampsia currently accounts for the majority of causes of perinatal morbidity and mortality. Umbilical artery Doppler (UAD) is a non-invasive effective method of antenatal fetal surveillance for early detection and prevention of potentially adverse perinatal outcome in preeclampsia. The objective of this study is to predict adverse perinatal outcome using UAD in Preeclampsia. Methods: This was a prospective cohort study in which 170 consecutively consenting women with preeclampsia were recruited. An UAD was done using Voluson P8 ultrasound. The pulsatility index, resistance index, systolic/diastole ratio. Reduced end diastolic flow, absent end diastolic flow and reversed end diastolic flow were measured. The participants were divided into two groups based on UAD indices findings. Both groups were followed up to determine their perinatal outcomes.The data was analyzed using SPSS version 20.0 for windows (IBM SPSS Inc, Chicago, IL, USA). Categorical variables were anal...
Role of Uterine Artery Doppler in Prediction of Pre Eclampsia And Its Foetal Outcome
Introduction: Preeclampsia during pregnancy is one of the major risk factors for maternal and fetal mortality in developing countries. After implantation in the uterine cavity, the arterial system that irrigates the endometrium and myometrium undergoes a series of changes which lead to the uteroplacental circulation. Such changes in the arterial system are a result of the deciduas invasion by the trophoblast. So uterine artery Doppler has become common in evaluation and management of pregnancy associated complication like fetal growth restriction. Aim:To known the role of Doppler study in prediction of preeclampsia and its outcome on maternal and fetal risk factors. Materials And Methods: 55 pregnant women who were more than 18 weeks included into study, with risk factors like family history of hypertension and previous history of preeclampsia , eclampsia, abruption, twins, etc except with women who were chronic hypertension and less than 18 weeks not
Screening utility of umbilical artery Doppler indices in patients with preeclampsia
Iranian Journal of Reproductive Medicine, 2010
1 Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Kerman, Iran. 2 Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. 3 Department of Radiology, Kerman University of Medical Sciences, Kerman, Iran. 4 Kerman University of Medical Sciences, Kerman, Iran. 5 Department of Community Medicine, Kerman University of Medical Sciences, Kerman, Iran. ... Abstract Background: Doppler indices of umbilical artery are used as indicator of fetal well being. Objective: To compare ...