Title: Fetal Doppler versus NST as predictor of adverse perinatal outcome in severe PIH and IUGR
Authors: Ch. Deependra Singh, S.S. Surana, S.A. Inamdar
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.71
Abstract
Background: A healthy mother and a healthy baby has been the prime objective of prenatal care since time immemorial. This has gained great importance in recent times. Hypertensive disorders during pregnancy is the most common medical complication about 7% of all primigravidas and a very common cause of IUGR.
The doppler flow velocimetry is the only means by which we can study the pathological changes in the placental bed before the clinical manifestations.
NST describe fetal heart rate acceleration in response to fetal movement as a sign of fetal health.
This study was undertaken to observe the doppler flow velocity in the umbilical artery compared with NST to predict perinatal outcome in high risk pregnancies.
Aims: To study fetal doppler waveform velocimetry and NST in PIH and IUGR patients and correlate with fetal outcome and prediction of fetal well being.
Settings and Design: An open, prospective ,randomized case control study.
Methods and Material: In this a randomized case control study was conducted on patients in the Department of obstetrics and gynaecology, Jawaharlal Nehru Medical college, Acharya Vinoba Bhave Hospital, Sawangi (Meghe) on 100 patients between july 2006 to September 2008.
Statiscal Analysis Used: Calculated as sensitivity , specificity ,positive predictive value and negative predictive value and the data analyzed by the chi- square method.
Results: In the group with abnormal NST but normal velocimetry, there were more women underlying caeserean delivery for fetal distress . Those with normal NST had 50% caeserean rate and 40% required NICU admission, fetuses with abnormal velocimetry who also had a non reactive NST are more susceptible to adverse outcome. Adverse perinatal outcome defined as fetal distress ,CS for fetal distress , admission to NICU.
The group having one abnormal test (doppler or NST) was not statiscally significant, when both test were abnormal , the outcome was statistically worse than the preceeding three groups ( P valve <0.001).
Conclusions: The sensitivity of NST was only 25% compared to 71.42% by doppler study where as the specificity of the two modalities was comparable 93.75% and 88.13% respectively.
Our study clearly indicates that abnormal doppler findings in umbilical artery is a reflection of unfavourable outcome to fetal mortality and morbidity as compared to NST.
As far as perinatal outcome is concerned it was more specifically observed in doppler study than NST study and a very reliable diagnostic modality in picking up cases at risk of adverse perinatal outcome.
Keywords: Doppler velocimetry, NST, PIH and IUGR patients.
