Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
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Assessment of Uterine Artery Umbilical Artery and Fetal MCA Doppler Velocimetry as Predictors of Adverse Outcome in Pregnancies Complicated by Third Trimester Oligohydramnios
E. Sathish Kumar, Rameez Rahiman, Haripriya and Pradhap Lenin
Page: 316-321 | Received 20 Jan 2024, Published online: 09 Mar 2024
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Abstract
To assess uterine, umbilical and fetal MCA artery Doppler velocimetry as potential indicators of adverse outcomes in pregnancies complicated by third trimester oligohydramnios and to determine which Doppler indicators are more important and useful in identifying fetuses that might have adverse outcomes. This is an observational correlational clinical study conducted over a period of 6 months from August 2023 to January 2024. This study included all booked single live intrauterine gestation more than 24 weeks with oligohydramnios (i.e. AFI<5 cm and borderline AFI <5‐8 cm) referred to the Department of Radiology for routine antenatal check‐up and all patients referred from Department of Obstetrics and Gynecology on the clinical suspicion of oligohydramnios in the third trimester. Pregnancies complicated by fetal anomalies, premature rupture of membrane, diabetes, hypertension, Rh incompatibility were excluded from this study. Thirty pregnant women in total were examined. After obtaining informed written consent, routine antenatal scan was performed and any fetuses with congenital anomalies were excluded from the study. For all patients, baseline investigations like hemoglobin percentage, urine examination, blood typing, NST and BPP were performed. The amniotic fluid volume was calculated using the four quadrant AFI technique. Oligohydramnios was defined as AFI <5 cm and borderline oligohydramnios was defined as AFI 5‐8 cm. Doppler indices were obtained for the umbilical artery, both uterine arteries and fetal MCA. Then patients were followed up according to the Doppler findings and AFI. Patients with oligohydramnios and normal Doppler were followed up every two weeks. Patients with abnormal Doppler were followed up every week till delivery. In patients with followed up Doppler, the last Doppler study prior to delivery was taken into consideration. All patients were followed up until delivery with NST, FMC and BPP and treated with L‐Arginine, oral rehydration and bed rest. Gestational age at the time of delivery, mode of delivery, fetal distress during normal delivery, nature of amniotic fluid, indication for caesarean section, APGAR at 1 and 3 minutes, birth weight and NICU admission were considered as the adverse outcome measures. AFI <5 cm and AFI 5‐8 cm in third trimester of pregnancy are both associated with adverse outcomes with severe oligohydramnios having increased incidence than borderline oligohydramnios. In identifying adverse outcomes, the presence of diastolic notch has the highest specificity and positive predictive value in the uterine artery while RI, PI and S/D ratio in the umbilical artery have good sensitivity, specificity, positive and negative predictive values with good accuracy. The cerebro‐placental ratio has the highest sensitivity, specificity, positive and negative predictive values with an accuracy of 56.67% among the MCA indices. Uterine artery, umbilical artery and fetal MCA Doppler velocimetry are all associated with increased incidence of adverse outcomes in both severe and borderline oligohydramnios. An abnormal study of all three vessels has the highest incidence of IUGR and NICU admission. We also found that adverse outcomes can still occur even if the Doppler of one vessel is abnormal and the other two are normal. Thus from our study, we conclude that for third trimester oligohydramnios, Doppler velocimetry of uterine, umbilical and fetal MCA together serve as good indicators of fetuses at risk of developing adverse outcomes for prompt management.
How to cite this article:
E. Sathish Kumar, Rameez Rahiman, Haripriya and Pradhap Lenin. Assessment of Uterine Artery Umbilical Artery and Fetal MCA Doppler Velocimetry as Predictors of Adverse Outcome in Pregnancies Complicated by Third Trimester Oligohydramnios.
DOI: https://doi.org/10.36478/10.59218/makrjms.2024.2.316.321
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2024.2.316.321