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BMC Pregnancy and Childbirth

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Open Access 01-12-2022 | Pre-Eclampsia | Research

Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting

Authors: Eman Mohamed Ibraheim Moawad, Amr Samir Fouad Tammam, Maha Mohamed Mosaad, Hadeer Mashaal El Sayed, Adel Atef

Published in: BMC Pregnancy and Childbirth | Issue 1/2022

Abstract

Background

Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP).

Methods

A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured.

Results

All UA indices were significantly higher in the case group compared to the controls (p < 0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p < 0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79, 72.8 and 73.3%, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52, 87 and 57%, respectively.

Conclusion

In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.

Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24–43. https://doi.org/10.1161/Hypertensionaha.117.10803.CrossRefPubMed

Belay AS, Wudad T. Prevalence and associated factors of pre-eclampsia among pregnant women attending anti-natal care at Mettu Karl referal hospital, Ethiopia: cross-sectional study. Clinical hypertension. 2019;25(1):14.CrossRef

WHO. Make every mother and child count, in the world health report 2005. Geneva: World Health Organization; 2005.

Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Roy M, Mittal S, Cecatti JG, Tunçalp Ö, Gülmezoglu AM. Maternal complications and perinatal mortality: findings of the world health organization multicountry survey on maternal and newborn health. BJOG. 2014;121:76–88.CrossRef

Neonatal mortality - UNICEF DATA. 2019. Available from: https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 17 Jan 2020.

Gathiram P, Moodley JJ. Pre-eclampsia: its pathogenesis and pathophysiology. Cardiovasc J Afr. 2016;27(2):71. https://doi.org/10.5830/CVJA-2016-009.CrossRefPubMedPubMedCentral

Tay J, Masini G, McEniery CM, Giussani DA, Shaw CJ, Wilkinson IB, Bennett PR, Lees CC. Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function. Am J Obstet Gynecol. 2019;220(1):96-e1. https://doi.org/10.1016/j.ajog.2018.09.017.CrossRefPubMed

Stevens W, Shih T, Incerti D, Ton TG, Lee HC, Peneva D, Macones GA, Sibai BM, Jena AB. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol. 2017;217(3):237–48. https://doi.org/10.1016/j.ajog.2017.04.032.CrossRefPubMed

Chhem RK. Radiology education the scholarship of teaching and learning. 2009.

10.

Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, Zeeman GG, Brown MA. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97–104. https://doi.org/10.1016/j.preghy.2014.02.001.CrossRefPubMed

11.

Leeman L, Dresang LT, Fontaine P. Hypertensive Disorders of Pregnancy. Am Fam Physician 15. 2016;93(2):121–7 PMID: 26926408.

12.

World Health Organization. ICD-10 : international statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization. 2004. https://apps.who.int/iris/handle/10665/42980.

13.

Novac MV, Iliescu DG, Tudorache S, Manolea M, Meetescu Re, Vrabie S, Novac MB, Alexandru DO, Dijmarescu L. Ultrasound evaluation of fetal biometry and Doppler parameters in the third trimester of pregnancy suspected of intrauterine growth restriction. Curr Health Sci J. 2018;44(1):23. https://doi.org/10.12865/CHSJ.44.01.04.CrossRefPubMedPubMedCentral

14.

National Institute for Health and Care Excellence Antenatal Care. NICE Clinical Guideline 62. London: NICE; 2008.

15.

Erman E, Retayasa W, Soetjiningsih S. Clinical gestational age assessment in newborns using the new Ballard score. Paediatr Indones. 2006;46(3):97–101.CrossRef

16.

Niklasson A, Albertsson-Wikland K. Continuous growth reference from 24th week of gestation to 24 months by gender. BMC pediatrics. 2008;8(1):8. https://doi.org/10.1186/1471-2431-8-8.CrossRefPubMedPubMedCentral

17.

Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W. Consensus definition of fetal growth restriction: a Delphi procedure. UOG. 2016;48(3):333–9. https://doi.org/10.1002/uog.15884.CrossRef

18.

Bahlmann F, Reinhard I, Krummenauer F, Neubert S, Macchiella D, Wellek S. Blood flow velocity waveforms of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinatol. 2002;30(6):490–501. https://doi.org/10.1515/JPM.2002.077.CrossRef

19.

Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. UOG. 53(4):465–72. https://doi.org/10.1002/uog.20157

20.

Yousif RA, Suliman AG, Aburaida RA, Daoud IM, Mohammed NE. Doppler ultrasound of umbilical artery in prediction of fetal outcome in pregnancy induced hypertension Sudanese population. Int J Res Med Sci. 2020;8(1):96–101. https://doi.org/10.18203/2320-6012.ijrms20195890.CrossRef

21.

Aali BS, Narooi S, Mojtabaean B, Nakhaee N. Screening utility of umbilical artery Doppler indices in patients with preeclampsia. Iranian J Repro Med. 2010;8(4):167.

22.

Lopez-Mendez MA, Martinez-Gaytan V, Cortes-Flores R, Ramos-Gonzalez RM, Ochoa-Torres MA, Garza-Veloz I, et al. Doppler ultrasound evaluation in preeclampsia. BMC Res Notes. 2013;6(1):1–6. https://doi.org/10.1186/1756-0500-6-477.CrossRef

23.

Ramos JG, Nelson C, Martins SH. Preeclampsia. Rev. Bras Ginecol Obstet, Rio de Janeiro. 2017; 39(9):496–512. PMID: 28793357. https://doi.org/10.1055/s-0037-1604471

24.

Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation. BJOG. 1985;92(1):31–8.CrossRef

25.

Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2017;(6). https://doi.org/10.1002/14651858.CD007529.pub4

26.

Ebrashy A, Azmy O, Ibrahim M, Waly M, Edris A. Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: case-control study. Croat Med J. 2005;46(5):821–5 PMID: 16158478.PubMed

27.

Lopez Molina PC, Molina Bolaños CC. Caracterización de pacientes con diagnóstico RCIU y su relación doppler en un centro de III Nivel de Popayán, periodo 2015–2016. 2018.

28.

VollgraffHeidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PM, Mol BW, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. UOG. 2018;51(3):313–22.

29.

Abdelwahid HH, Wahab BA, Mahmoud MZ, Abukonna A, Taha EA. Effects of gestational hypertension in the pulsatility index of the middle cerebral and umbilical artery, cerebro-placental ratio, and associated adverse perinatal outcomes. J Radiat Res Appl. 2018;11(3):195–203. https://doi.org/10.1016/j.jrras.2018.02.001.CrossRef

30.

Najam R, Gupta S. Predictive value of cerebroplacental ratio in detection of perinatal outcome in high-risk pregnancies. J Obstet Gynecol India. 2016;66(4):244–7. https://doi.org/10.1007/s13224-015-0671-3.CrossRef

31.

Morris RK, Say R, Robson SC, Kleijnen J, Khan KS. Systematic review and meta-analysis of middle cerebral artery Doppler to predict perinatal wellbeing. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):141–55. https://doi.org/10.1016/j.ejogrb.2012.07.027.CrossRefPubMed

32.

Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86–98. https://doi.org/10.1159/000357592.CrossRefPubMed

33.

Uquillas KR, Grubbs BH, Prosper AE, Chmait RH, Grant EG, Walker DK. Doppler US in the evaluation of fetal growth and perinatal health. Radiographics. 2017;37(6):1831–8. https://doi.org/10.1148/rg.2017170020.CrossRefPubMed

34.

Novac MV, Moldoveanu A, Tudorache Ş, Oprescu ND, Miescu M, Siminel MA, Vrabie S, Novac MB, Iliescu DG. Utility of cerebroplacental ratio in IUGR fetuses from pregnancy with preeclampsia in prediction the risk for perinatal complications. Curr Health Sci J. 2017;43(3):231. https://doi.org/10.12865/CHSJ.43.03.08.CrossRefPubMedPubMedCentral

35.

Eslamian ZL, Zarean E, Moshfeghi M, Heidari Z. Evaluation of the predictive value of fetal Doppler ultrasound for neonatal outcome from the 36th week of pregnancy. J Res Med Sci. 2018;23. https://doi.org/10.4103/jrms.JRMS_133_17

36.

Khalil A, Morales-Rosello J, Khan N, Nath M, Agarwal P, Bhide A, Papageorghiou A, Thilaganathan B. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? AJOG. 2017;1216(6):606-e1. https://doi.org/10.1016/j.ajog.2017.02.005.CrossRef

37.

Flood K, Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study. AJOG. 2014;211(3):288-e1. https://doi.org/10.1016/j.ajog.2014.05.008.CrossRef

38.

Regan J, Masters H, Warshak CR. Association between an abnormal cerebroplacental ratio and the development of severe pre-eclampsia. J Perinatol. 2015;35(5):322–7. https://doi.org/10.1038/jp.2014.210.CrossRefPubMed

39.

Shahinaj R, Manoku N, Kroi E, Tasha I. The value of the middle scerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prsenat Med. 2010;4(2):17 PMC3279170.

40.

Erez O, Romero R, Maymon E, Chaemsaithong P, Done B, Pacora P, Panaitescu B, Chaiworapongsa T, Hassan SS, Tarca AL. The prediction of late-onset preeclampsia: results from a longitudinal proteomics study. PLoS One. 2017;12(7):e0181468. https://doi.org/10.1371/journal.pone.0181468.CrossRefPubMedPubMedCentral

41.

Surico D, Bordino V, Cantaluppi V, Mary D, Gentilli S, Oldani A, Farruggio S, Melluzza C, Raina G, Grossini E. Preeclampsia and intrauterine growth restriction: role of human umbilical cord mesenchymal stem cells-trophoblast cross-talk. PloS One. 2019;14(6):e0218437. https://doi.org/10.1371/journal.pone.0218437.CrossRefPubMedPubMedCentral

42.

Srinivas SK, Edlow AG, Neff PM, Sammel MD, Andrela CM, Elovitz MA. Rethinking IUGR in preeclampsia: dependent or independent of maternal hypertension? J Perinatol. 2009;29(10):680–4. https://doi.org/10.1038/jp.2009.83.CrossRefPubMedPubMedCentral

43.

Gomathy E, Akurati L, Radhika K. Early-onset and late-onset preeclampsia-maternal and perinatal outcomes in a rural tertiary health center. IJRCOG. 2018;6:2266–9. https://doi.org/10.18203/2320-1770.ijrcog20182333.CrossRef

44.

Wicaksono B, Intan R, Utomo B P103. Relationship between severe preeclampsia onset with IUGR incidence at Dr Soetomo general hospital in 2013. Pregnancy Hypertens. 2015;5(3):257. https://doi.org/10.1016/j.preghy.2015.07.121.CrossRef

45.

Susilo SA, Pratiwi KN, Fattah AN, Irwinda R, Wibowo N. Determinants of low APGAR score among preeclamptic deliveries in Cipto Mangunkusumo Hospital: a retrospective cohort study in 2014. MJI. 2015;24(3):183–9. https://doi.org/10.13181/mji.v24i3.1229.CrossRef

46.

Ahmadpour-Kacho M, Asnafi N, Javadian M, Hajiahmadi M, Taleghani N. Correlation between umbilical cord pH and Apgar score in high-risk pregnancy. Iran J Ped. 2010;20(4):401 PMCID: PMC3446088 PMID: 23056738.

47.

Fratelli N, Brunelli VB, Gerosa V, Sartori E, Lojacono A, Prefumo F. Correlation between fetal Doppler indices and neonatal acid–base status at birth in healthy appropriate for gestational age term fetuses. Arch Gynecol Obstet. 2019;300:1827–30. https://doi.org/10.1007/s00404-019-05356-w.CrossRefPubMed

48.

Beljan P, Elveđi-Gašparović Ve, GverićAhmetašević Sn, Schuster S, Skrablin S. What affects the outcome of severe preeclampsia? Signa Vitae: J Intesive Care Emerg Med. 2015;10(Suppl 1):6–12.

49.

Oskovi Kaplan ZA, Ozgu-Erdinc AS. Prediction of preterm birth: maternal characteristics, ultrasound markers, and biomarkers: an updated overview. J pregnancy. 2008;10:2018. https://doi.org/10.1155/2018/8367571.CrossRef

50.

Fardiazar Z, Atashkhouei S, Yosefzad Y, Goldust M, Torab R. Comparison of fetal middle cerebral arteries, umbilical and uterine artery color Doppler ultrasound with blood gas analysis in pregnancy complicated by IUGR. Iran J Reprod Med. 2013;11(1):47 PMCID: PMC3941376 PMID: 24639692.PubMedPubMedCentral

51.

Francisco RP, Miyadahira S, Zugaib M. Predicting pH at birth in absent or reversed end-diastolic velocity in the umbilical arteries. Obstet Gynecol. 2006;107(5):1042–8. https://doi.org/10.1097/01.AOG.0000209192.00890.3a.CrossRefPubMed

Title: Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting
Authors: Eman Mohamed Ibraheim Moawad
Amr Samir Fouad Tammam
Maha Mohamed Mosaad
Hadeer Mashaal El Sayed
Adel Atef
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Pre-Eclampsia
Published in: BMC Pregnancy and Childbirth / Issue 1/2022
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-022-04704-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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