Title: The Role of Ultrasound in the Assessment of Fetal Growth and Placental Maturation in Pregnancy Induced Hypertension
Authors: Alaa Eldin Mohamed Abd Elhameid, Tarek Abd Elzaher Karkour, Moataz Mohamed Montasser, Shimaa Mohamed Shaban
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.45
Aim:This study was undertaken to evaluate the role of grey scale and Doppler ultrasound in the assessment of fetal growth and placental maturation in pregnancy induced hypertension (PIH). Methods:Forty pregnant female diagnosed as pregnancy induced hypertension were included. History taking, general and obstetric examination as well as laboratory investigation were done. The periodic follow up was included grey scale ultrasound (fetal biometry, placenta grade and liquor assessment) and Doppler ultrasound (umbilical artery, middle cerebral artery and fetal aorta blood flow). The perinatal outcome results included intrauterine growth retardation (IUGR), prematurity, intrauterine fetal death (IUFD) and early neonatal death were documented and correlated with the ultrasound findings. Results: There was increased incidence of Grade III placenta in pregnant females with PIH as there were 40 %( n=16) had grade II placenta while 60 %( n=24) had grade III placenta. There was an association between grade III placenta and intrauterine growth retardation. All patients presented with IUGR (n=9) showed abnormal Doppler waveforms. Eight of them had abnormal MCA/UA ratio and only one expressed normal ratio. Increased number of vessels affection was associated with adverse pregnancy outcome as IUGR, prematurity, IUFD and early neonatal death. Umbilical artery Doppler with absent or reversed diastolic flow was ominous signs as both findings were associated with IUFD and neonatal death. Conclusion: Fetal ultrasound has a valuable role in predicting adverse perinatal outcome associated with PIH. It has important role in assessment of placental maturation and its effect on fetal growth and placental dysfunction. Doppler imaging can significantly evaluate complication associated with PIH by providing valuable information about the hemodynamic state of the fetus. Keywords: PIH, grey scale ultrasound, Doppler ultrasound, Umbilical artery, Middle cerebral artery, Cerebroplacental ratio, IUGR. 1. Khalid M, Wahab S, Kumar V, Khalid S, Haroon S, Sabzposh N A. Doppler Indices in Prediction of Fetal Outcome in Hypertensive Pregnant Women. NJOG 2011; 6 (1): 28-34. 2. Watanabe K , Naruse K , Tanaka K , Metoki H , Suzuki Y. Outline of Definition and Classification of “Pregnancy induced Hypertension (PIH)” . Hypertens Res Pregnancy 2013; 1: 3–4. 3. MAYER C and JOSEPH K. S. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet Gynecol 2013; 41: 136–145 4. Mustafa R, Ahmed S, Gupta A, Venuto C R. A Comprehensive Review of Hypertension in Pregnancy. Journal of Pregnancy, 2012;18:19. 5. Lausman A, Walker M. Screening, Diagnosis, and Management of Intrauterine Growth Restriction. J Obstet Gynaecol Can 2012;34(1):17–28. 6. Lakhkar B N, Rajagopal K Vv, Gourisankar P T. Doppler Prediction of Adverse Perinatal Outcome in PIH and IUGR. Ind J Radiol Imag 2006 16:1:109-16. 7. Shahinaj R, Manoku N, Kroi E, Tasha I. 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(2)17-21. 8. Grannum PA, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol 1979;133:915–22. 9. Lindheimer MN, Taler SJ, Cunningham FG. ASH Position Paper: Hypertension in Pregnancy. J Clin Hypertens . 2009;11:214–225. 10. Rasmussen S and Irgens LM. History of Fetal Growth Restriction Is More Strongly Associated With Severe Rather Than Milder Pregnancy-Induced Hypertension. Hypertension. 2008;51:1231-1238. 11. Benson CB, Doubilet PM and Saitzman DH: Intrauterine growth retardation: Predictive value of ultrasound criteria for antenatal diagnosis, Radiology.2005; 160: 415-17. 12. Deopa D, Ramesh CS, Dubey K, Aneja S. Comparison Of Placental Grading By Ultrasonographic Study In Normal And High Risk Pregnancy In North Indian Population. J Anat.Soc.India.2011; 60(1)31-36. 13. McKenna D, Tharmaratnam S, Mahsud S, Dornan J. Ultrasonic Evidence of placental calcification at 36 weeks’ gestation: Maternal and fetal outcomes. Acta Obstet Gynecol Scand. 2005; 84: 7–10. 14. Chen KH, ChenLR and Lee YH.The Role of Preterm Placental Calcification in High-Risk Pregnancy as a Predictor of Poor Uteroplacental Blood Flow and Adverse Pregnancy Outcome. 2012; 38( 6): 1011–1018 15. Joseph k, Hassan N, HussainR, Akhtar MT .Effects Of Variation In Umbilical Artery Resistive Index On Placental Morphology And Birth Weight In Pregnancy Induced Hypertension. J Ayub Med Coll Abbottabad. 2013;25:3-4. 16. Nwosu Z, Omabe M. Maternal and Fetal Consequences of Preeclampsia. The Internet Journal of Gynecology and Obstetrics. 2009;13:1. 17. Hoffman C and Galan HL. Assessing the ‘at-risk’ fetus: Doppler ultrasound. Curr Opin Obstet Gynecol, 2009; 21:161–66. 18. Yoon BH, Lee CM, Kim SW. an abnormal umbilical artery waveform; a strong and independent predictor of adverse perinatal outcome in patients with pre eclampsia – American journal of obstetrics and gynecology. 1994; 171:713-721. 19. Özgür Ö, Karamürsel BS, Armangil D, Önderoğlu LS, Yiğit S, Velipaşaoğlu M, Deren Ö. Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications. The Turkish Journal of Pediatrics .2010; 52: 384-392. 20. Deshmukh V, Yelikas KA, Deshmukh P. Cerebral-umbilical Doppler ratio as predictor of perinatal outcome in pregnancies with hypertension disorders. Journal of Evolution of Medical and Dental Sciences 2013; l2,(38): 7366-7372. 21. Smitha K, Sowmya K, Malathi T. Study of Doppler waveforms in pregnancy induced hypertension and its correlation with perinatal outcome.Int J Reprod Contracept Obstet Gynecol. 2014 ;3(2):428-33.Abstract
References