K. Sujatha, J. Srimathi, S. Padmanaban
BACKGROUND Preeclampsia which is one of the five hypertensive disorders of pregnancy is common with an incidence of 6-8% and form one of the deadly triad, along with haemorrhage and infection, that contribute greatly to maternal morbidity and mortality. Foetal growth restriction is estimated to occur in 3-10% of the infants. The perinatal morbidity and mortality are significantly increased among these growth restricted infants. Diseases that may be causes of perinatal mortality and morbidity such as preeclampsia, intrauterine growth retardation (IUGR) are often seen in the third month or even just before the time of birth but the pathophysiologic mechanisms are believed to originate at the earlier times in pregnancy. During the period of a normal pregnancy beginning from the first three months till the 24th week, becoming more evident as time goes by, there is an increase in the diastolic blood flow of the uterine vessels. The above said diseases are associated with increased impedance to blood flow. This can be detected by uterine artery Doppler velocimetry as early as the beginning of second trimester. Doppler Ultrasound has been demonstrated to be a reliable non-invasive method of examining utero-placental perfusion. Thus, Uterine artery Doppler studies are common for both preeclampsia and adverse foetal outcome as a screening test because the impairment of placental perfusion is common in both. This study is designed to test the efficacy of uterine artery Doppler study done between 11-14 weeks as a single stage screening test for early prediction of preeclampsia and foetal growth restriction. MATERIALS AND METHODS Prospective observational study. 330 pregnant women who attended the antenatal care for measuring nuchal translucency at 11-14 weeks at the Sri Ramachandra Medical College & Research Institute, were recruited into the study. of which 320 patients could be followed up to term were included in the study. RESULTS The mean Pulsatility index was calculated and the 95th centile was ascertained as 2.98 and did not change significantly with foetal CRL. Of the total 320 cases, the mean PI was more than 95th centile in 16 (5%) cases and for 304 cases (95%) it was less than 2.98. The lowest PI observed was 0.8 and the highest being 3.75. In the study, the mean age for the 16 cases with mean PI >2.98 is 27.5 years and the mean age for the 304 cases with mean PI <2.98 is 26.8 years. Of the total 182 number of primigravida, 11 were having the mean PI >95th centile (68.8%) when compared to the 138 multigravida those who have the mean PI >95th centile are only 5 (31.3%). CONCLUSION In the future, uterine artery screening will probably be combined with biochemical markers of platelet activation or endothelial damage to further improve the screening results. Further studies are still necessary to determine how information from uterine artery Doppler studies should modify current practice in high risk women.
