DOPPLER EVALUATION OF FETOPLACENTAL AND UTEROPLACENTAL CIRCULATION OUTCOMES IN WOMEN WITH PRE-ECLAMPSIA: COMPARISON AND CORRELATION BETWEEN DIFFERENT DOPPLER PARAMETERS

  • SIPAL RAMADHAN HASAN Department of Radiology, Azadi Teaching Hospital, Directorate of Health, Duhok, Kurdistan Region, Iraq
  • SOHAIB HASAN ALI Lecturer, Surgery Department, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Keywords: Doppler Parameters, Kurd, Iraq, pre-eclampsia

Abstract

https://doi.org/10.31386/dmj.2023.17.2.4

Background: Preeclampsia (PE) affects between 5% and 8% of all pregnancies and is one of the leading cause of maternal mortality in underdeveloped countries.PE is characterized by the new onset of high blood pressure and proteinuria with or without body swelling that occurs after 20 weeks of gestation and lasts up to 6 weeks after labor. The pathophysiology of PE is based on the incapability of the trophoblast to invade the myometrium properly causing improper remodeling of spiral arteries resulting in fetoplacental insufficiency and this can be detected by using Doppler ultrasound.

Objective:  To compare and correlate among cerebroplacental ratio (CPR), uterine artery, umbilical artery, and middle cerebral artery (MCA) parameters outcomes in established cases of pre-eclampsia

Patients and methods: A total 36 cases of pregnant women who were diagnosed clinically and by laboratory investigation as preeclampsia were included in this study in cross-sectional study to evaluate fetoplacental and uteroplacental circulation using Doppler parameters such as pulsatility index (PI) and cerebroplacental ratio.

Results: There was a strong correlation between the cerebroplacental ratio and Middle cerebral artery PI (p-value =0.0006); however, a minimum positive correlation was found between CPR and umbilical artery (UmA) and uterine artery (UTA)  p=0.0274 and 0.0244 respectively

Conclusion: A positive correlation found between CPR PI and MCA, UTA, UmA pulsatility indices; therefore, we conclude that they can be used as complementary to each other in we conclude that they can be used as complementary to each other for identifying high-risk pregnancies, early detection of fetal compromise and consequently optimizing the timing of intervention.

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References

1. Coleman MAG, McCowan LME, North RA. Mid-trimester uterine artery doppler screening as a predictor of adverse pregnancy outcome in high-risk women. Ultrasound in Obstetrics and Gynecology. 2000;15:7–12.
2. Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi MT, Romero R, Lee W, et.al "Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension?" Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2010;29(7):1103-1115.
3. Szarka A, Rigó J Jr, Lázár L, Bekő G, Molvarec A. Circulating cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia determined by multiplex suspension array. BMC Immunology. 2010;11:1-9.
4. Karge A, Mueller S, Findeklee S, Rody A, Kohl M, Hoyer D, et al. Value of cerebroplacental ratio and uterine artery doppler as predictors of adverse perinatal outcome in very small for gestational age at term fetuses. J Clin Med. 2022;11:3852.
5. Lopez-Mendez MA, Orozco-Gregorio H, Ibarra-Ramirez M, Gallegos-Rangel R, Chacon-Cruz E. ''Doppler ultrasound evaluation in preeclampsia''. BMC Res Notes. 2013;6:500.
6. Ratiu D, Suciu N, Voidazan S, Dudea M, Szabo I, Horvat T, Copotoiu SM. Doppler indices and notching assessment of uterine artery between the 19th and 22nd week of pregnancy in the prediction of pregnancy outcome. In Vivo. 2019;33(6):2199-2204.
7. Kennedy AM, Woodward PJ. "A radiologist’s guide to the performance and interpretation of obstetric doppler US". Radiographics. 2019;39:893–910.
8. Maulik D, Zalud I. Doppler ultrasound in obstetrics and gynecology: 2nd revised and enlarged edition Doppler ultrasound in obstetrics and gynecology. Springer; 2005.
9. Elsharkawy RT, Ahmed M, Elsayed S, Ayyad S. Cerebroplacental doppler ratio and cerebrouterine doppler ratio in predicting neonatal outcome in preeclamptic pregnant women. Journal of Advances in Medicine and Medical Research. 2022;4:7–15.
10. Patil V, Zawar P, Joshi A, Khatib N, Shah M, Chaudhari C. Cerebro-placental ratio in women with hypertensive disorders of pregnancy: a reliable predictor of neonatal outcome. J Clin Diagn Res. 2019;13(8):QC07–QC10.
11. Davison JM, Homuth V, Jeyabalan A, Conrad KP, Karumanchi SA, Quaggin S, et al. New aspects in the pathophysiology of preeclampsia. Journal of the American Society of Nephrology. 2004;15:2440–48.
12. Nicolaides K, Rizzo G. Doppler in obstetrics. In: Placental and Fetal Doppler. 2000;105–19.
13. Konwar R, Dutta S, Borthakur S, Gogoi D, Bhattacharyya S, Narayanan A, et al. Role of doppler waveforms in pregnancy-induced hypertension and its correlation with perinatal outcome. Cureus. 2021;13.
14. Norton ME, Feldstein VA. Callen's Ultrasonography in Obstetrics and Gynecology. 6th ed. Philadelphia: Elsevier; 2017.
15. Baschat AA, Gembruch U. The cerebroplacental doppler ratio revisited. Ultrasound in Obstetrics and Gynecology. 2003;21:124–27.
16. Ebbing C, Rasmussen S, Kiserud T. ''Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements''. Ultrasound Obstet. and Gynecol. 2007;30:287–96.
17. Rabou IB, Mohammed HA, Mohammed HA, Abdullah KM, Al-Ezzi MR. Correlation between cerebroplacental ratio and umbilical artery Doppler with pregnancy outcome in postdates Iman. BMC Pregnancy Childbirth. 2020;20(1):474.
18. Li G, Gudnason H, Olofsson P, Dubiel M, Westgren M. Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one-third of late third-trimester pre-eclamptic women. Ultrasound in Obstetrics and Gynecology. 2005;25:459–63.
19. Sharbaf FR, Rostami N, Amirpour-Najafabadi M, Kalantari ME, Tohidi F. Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction. Biomedical Research and Therapy. 2018;5(2):2296-2304.
20. Saber HM, Khamis M, Alser KA, Mowafy HE. Role of middle cerebral artery / umbilical artery pulsatility index ratio (cerebro-placental ratio CPR) for prediction of fetal outcome in preeclamptic patients. Sohag Medical Journal. 2019;23(2):177-182.
21. Srikumar D, Ravikumar B, Maurya DK. Doppler indices of the umbilical and fetal middle cerebral artery at 18–40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(3):232-241.
22. Moawad EMI, El-Gharib MN, Samir M, Fawzy M, Said M, Elwan A, Farouk A, Baky RM, El Sayed Aly S, Hassanein HM, El Shafie MA. 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. BMC Pregnancy Childbirth. 2022 Jan;22(1):52.
23. Shahinaj R, Myrtaj E, Koçinaj D, Gashi Z, Krasniqi V, Gashi A, Gashi F. The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prenat Med. 2010;4(1):17-21. PMID: 24363922.
24. Kumar S, Kumar S, Thakur M. Study of Doppler waveforms in pregnancy induced hypertension and its correlation with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2014;3(2):428-433.
25. Khalil A, Morales-Rosellõ J, Townsend R, Morlando M, Papageorghiou A, Bhide A, et al. Value of third-trimester cerebroplacental ratio and uterine artery doppler indices as predictors of stillbirth and perinatal loss. Ultrasound in Obstetrics and Gynecology. 2016;47:74–80.
Published
2023-12-30
How to Cite
RAMADHAN HASAN, S., & HASAN ALI, S. (2023). DOPPLER EVALUATION OF FETOPLACENTAL AND UTEROPLACENTAL CIRCULATION OUTCOMES IN WOMEN WITH PRE-ECLAMPSIA: COMPARISON AND CORRELATION BETWEEN DIFFERENT DOPPLER PARAMETERS. Duhok Medical Journal, 17(2), 32-41. Retrieved from http://dmj.uod.ac/index.php/dmj/article/view/258