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Abstract
Assessment of fetal well being in utro forms an important item of prenatal surveillance. Antenatal prediction and identification of the fetuses at risk for preventable morbidity and mortality can help in improvement of outcome for the mother and her baby in most cases. The main methods of fetal surveillance in high risk pregnancy including severe preeclampsia are non stress test and ultrasound biophysical profile.
The past decade has seen an increasing interest in Doppler ultrasound as it provides non invasive access to uteroplacental and fetal circulation and therefore might yield direct information on pathophysiology of vascular insufficiency.
The aim of this work was to compare between CTG (non stress test) and Doppler velocimetry in the form of MCA/UA ratio in prediction of fetal compromise and bad fetal outcome in mothers with severe preeclampsia in order to find an ideal method for fetal surveillance.
This study included 50 females with a singleton pregnancy suffering from severe preeclampsia .Their gestational age ranged between 32 weeks and 40 weeks gestation.Patient were admitted in High risk departement ,Obstetric & Gynecology Departements- Zagazic University hospitals between period between April 2010 and November
All these cases were subjected to the following:
I) Before labor:
1- Detailed history taking.
2- Complete general examination.
3- Obstetric examination.
4- Full laboratory investigations including.
5- Transabdominal obstetric ultrasonography to estimate the following :-
• Gestational age.
• Fetal weight (using combination of femur length, abdominal circumference, head circumference and biparietal diameter) to detect any evidence of intrauterine growth retardation.
• Doppler velocimetries of both umbilical and fetal middle cerebral arteries to estimate resistance index (RI), pulsitility index (PI) and systolic/ Diastolic (S/D) and to detect MCA/UA ratio
5- Electronic foetal monitoring (non stress test):
Using cardiotoccogram (CTG) to be repeated every other day till time of delivery
6- Follow up and observation of the patients.
The blood pressure was measurement every 6 hours, laboratory investigation and CTG every other day, and Doppler ultrasound weekly.
II) After labor:-
- Mode of delivery.
- Gestational age at delivery.
- Birth weight.
-Apgar score at 1 and 5 minutes.
-Admission to NICU and any other complication
The data obtained were collected, tabled and statistically analyzed
In our study we classify our patient into four groups to compare between Doppler changes and NST in prediction of fetal outcome in severe preeclampsia as following:
• Group A: Normal CTG (non stress test), Normal MCA/UA ratio (>1) and include 14 cases
• Group B: Normal CTG (non stress test), Abnormal MCA/UA ratio (<1) and this represent abnormal Doppler and include 12 cases.
• Group C: Abnormal CTG (non stress test), Normal MCA/UA ratio (>1) and this represent abnormal CTG and include 12 cases.
• Group D: Abnormal CTG (non stress test), Abnormal MCA/UA ratio (<1) and this represent combination of both and include also 12 cases.
Our study revealed that abnormal MCA/UA ratio is more sensitive but less specific than non reactive CTG (non stress test) in prediction of bad fetal out come in mothers with severe preeclampsia.
By test combination which considered MCA/UA ratio <1 and non reactive CTG (non stress test) as potentially pathological, the sensitivity for prediction of bad fetal out come was significantly increased. As we found ,after combination into 4 groups, that there is significant difference between the 1st three groups (A,B,and C) and the 4th group (D) as regard gestational age at delivery ,mode of delivery , fetal body weight, fetal complication and admission to NICU and numbers of the days of stay.
Conclusion
The result of this study provides an evidence that Doppler study of MCA/UA ratio is valuable in assessment of fetal well being and in prediction of abnormal fetal outcome in severe preeclampsia.
The study of MCA/UA ratio provides a superior screening test for recognition of fetal compromise than CTG (non stress test) in severe preeclampsia. However termination of pregnancy doesn’t consider abnormal MCA/UA ratio but only occurs if there is absent or reversed end diastolic flow of umbilical artery Doppler velocimetry or if there is non reactive NST.
By test combination which considered MCA/UA ratio <1 and non reactive CTG (non stress test) as potentially pathological, the sensitivity for prediction of bad fetal out come was significantly increased.