ROLE OF CEREBROPLACENTAL RATIO OF DOPPLER VELOCIMETRY TO DETERMINE IMMEDIATE PERINATAL OUTCOME IN HYPERTENSIVE DISORDERS OF PREGNANCY IN A TERTIARY CARE HOSPITAL
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Abstract
BACKGROUND: Hypertensive disorders are the most common pregnancy related complications with an incidence of 5-10% of all pregnancies and has a substantial impact on mother and perinatal morbidity and mortality. Doppler evaluation of blood flow through the cerebral vessels will allow for the detection of altered cerebral circulation even before significant fetal heart rate changes due to hypoxemia. In this study, we aimed to To study determine immediate perinatal outcome in hypertensive disorders of pregnancy using cerebroplacental ratio by combining vessels like umbilical artery and middle cerebral artery.
METHODOLOGY: A total of 200 participants are selected sure of their date of the last menstrual period and had regular menstrual cycles previously. Their gestational age is further corroborated by first trimester ultrasound. All the antenatal women planned on induction or presented in labor are examined by routine ultrasound scan and Doppler subsequently. Blood flow velocity waveforms of UA and MCA are obtained with pulsed Doppler ultrasound equipment. The peak systolic, end diastolic and mean velocity are recorded from these vessels and Umbilical artery S/D ratio, PI, RI and Middle Cerebral Artery PI, RI, S/D and CPR are calculated
RESULTS: In this study, most of the women were in the age group 20 – 29 yrs.. Most of them were gestational hypertension 55%, followed by preeclampsia and eclampsia contributing to 40.5% and the remaining were chronic hypertensives and with superimposed preeclampsia. 16% of the babies had NICU admissions for more than 24hrs for complications like low birth weight with foetal distress, birth asphyxia, meconium aspiration syndrome and- hypothermia. The overall diagnostic accuracy of predicting adverse perinatal outcome is 79.50% with Cerebroplacental ratio and 70% with UA PI which proves the former to be a better predictor.
CONCLUSIONS: The study states that cerebroplacental ratio is a better tool for assessing immediate perinatal outcome. It has good accuracy for determining low birth weight and APGAR <7. Compared to other methods of foetal monitoring, the use of Doppler has proved to be more sensitive in detecting foetal compromises early and helps in aiding appropriate and timely delivery.