Doppler Ultrasound as Predictor of Obstetric Outcome in High Risk Pregnancy

Objectives To determine and compare diagnostic accuracy of Doppler of Uterine Artery, Umbilical Artery, Middle Cerebral artery& Ductus Venosus in high risk pregnancy. To study prognostic efficacy of Doppler in early detection of fetal compromise. Method A prospective study comprising 110 patients of high risk pregnancy having IUGR admitted in Civil Hospital, OBGY Department, B. J. Medical College from JUNE 2016 to MAY 2017. Doppler examination of Uterine Artery, Umbilical Artery, Middle Cerebral Artery& Ductus Venosus was done after recording patients history, clinical examination and ultrasound. Mode of delivery, perinatal outcome. A comparison was carried out between the Doppler indices of above mentioned vessels in predicting the perinatal outcome& deciding the further management. Result Bilateral diastolic notches in uterine artery had highest specificity (93.02 %) and highest PPV (85 %) for prediction of abnormal perinatal outcome. Using 95th percentile as a cutoff for raised S/D ratio, 12 out of 31 patients had abnormal perinatal outcome. UA S/D ratio has sensitivity 0f 69.7 %, specificity 81.6 %, PPV 67.6 %& NPV 83.05 %.10 out of 16 patients who had reduced diastolic flow of UA had abnormal perinatal outcome& none of those who had AEDF or REDF had normal perinatal outcome.27 out of 41 patients having low MCA PI had abnormal perinatal outcome. Of all tests, Cerebro-umbilical Ratio has highest sensitivity 52.5 %& Specificity 92.8 % for predicting the outcome. All patients with abnormal Ductus venosus flow had abnormal perinatal outcome.50 % underwent Caeserian Section and in 60 % cases indication for LSCS was fetal distress. Conclusion Use of Doppler ultrasound in high risk pregnancy appears to improve the obstetric care& outcome. It helps in reducing perinatal deaths. Increasing UA PI and decreasing MCA PI are the early markers for detection of fetal compromise. Ratio of indices between MCA PI& UA PI reflects brain sparring effects as well as placental insufficiency and these are more specific in detection of IUGR than individual arteries.