الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
of the disease and picking up of the severe cases with subsequent early management and intervention. The second line of defense mechanism which would carry the lowest maternal and fetal morbidity and mortality is the aggressive management of severe cases of pre-eclampsia.
Although Preeclampsia is usually a disease of first pregnancy the risk of recurrence is higher in the second pregnancy compared with women who have had a normal first pregnancy.
Doppler ultrasound:
The use of Doppler ultrasound is not new in obstetric practice. It produces an immense amount of hemodynamic information from a circulation. The use of technique for fetal investigations was first reported 1977.
Methods of analysis:
Doppler blood flow may be analyzed in three ways by:
1. Waveform.
2. Resistance indices.
Flow volume or velocity.
Characteristically, the flow velocity wave form has an ascending and descending corresponding to both systole diastole respectively uterine artery viscometer provides information that is uniquely information in the management of normal and abnormal pregnancies, the main advantage of uterine artery Doppler is that it’s an early prediction, non invasive and it may be remarkably change the individual management in each high risk case and consequently affect maternal and neonatal out come.
There were significant difference in the analysis of the umbilical artery Doppler between normally grown and IUGR infant.
The vessels most easily investigated by this incidence are the middle cerebral arteries because they are oriented toward the Doppler Transducer this case the angle between the vessel axis and the Doppler beam is close to zero and maximum Doppler frequency. On the bipartitely examination the middle cerebral arteries are found on a transverse line passing anterior to the cerebral peduncle.
The flow velocity in the middle cerebral artery is highly pulsatile and the frequency of detectable end diastolic flow the increases with advancing gestation. In fetuses with IUGR resistance indices in all major intracranial arteries are significant reduced. It is thought that a hormonally medicated increase in fetal peripheral vascular resistance occurs so that the cerebral, cardiac and adrenal blood flow is preserved. This phenomenon results in the ”Brain Sparing Effect”.
After delivery the traditional way to assess the newborn is to use the Apgar score at (5) minute which was devised by Virginia Apgar and grades five clinical criteria with scores from 0 to 2 at 1 minute and at 5 minute after delivery.
It was found that fetal middle cerebral artery to umbilical artery (PI) ratios and fetal middle cerebral to uterine artery (PI) ratios are good indices to predict the unfavorable out com of pregnancies presented in:
1. Preterm labour.
2. Neonatal admission to neonatal intensive care unities.
3. Decreased Apgar scor.
4. IUGR. (Decreased Apgar score, Neonatal admission to Neonatal Intensive Care Unit, Intra uterine fetal death or in early neonatal period).
It was found that preeclampsia cases when followed up by routine antepartum fetal surveillance, such as non-stress test and fetal biophysical profile, it is very difficult to predict which fetus is going to be complicated with broad scale of false positive and false negative results.
But when the Doppler studies of fetal middle cerebral PI, umbilical artery PI and uterine artery PI MCA/umbilical PI and MCA/uterine PI Ratios were added, there is statistical deference which is significant that states when there is an abnormal MCA/UA PI and MCA/uterine PI Ratios there is great possibility that this baby is suffering intrauterine and decision of termination may be of value to avoid further intra uterine complications.
Conclusion
It was found a strong correlation between the MCA/UA (PI) and MCA/ UT (PI) Ratio and neonatal outcome, in fact the present study indicates that a normal MCA/UA (PI) and MCA/uterine (PI) ratio is a strong predictor of a normal fetal outcome, while an abnormal result