The case group (Group I) was comprised of sixty women with a viable singleton pregnancy ≥ 34 weeks, complicated by LOP with severe features and delivered by caesarean section (CS) who consented to participate.
Study populationĪll childbearing women who presented to the Labor and Delivery triage unit at Kasr Al Aini hospital during a six- month study period were screened for eligibility. The sample size was obtained to yield a 95% confidence level, 5% margin of error with anticipated response rate 80%. The department incorporates six inpatient units, surgery, antenatal care, and fetal medicine with 297 bed capacity. All study participants were recruited from Obstetrics and Gynecology Department, Kasr Al Aini Hospital that serves as a tertiary referral center for more than 220 thousand women across Egypt and Middle East region annually. We conducted a hospital-based prospective, cross-sectional study included a cohort of childbearing women ≥ 34 weeks of gestation with severe PE (case group) and group of matched healthy childbearing females (control group) between September 2018 and March, 2019. Therefore, we evaluated the umbilical artery (UA) and middle cerebral artery (MCA) with cerebroplacental ratio (CPR) using different Doppler ultrasound parameters to detect its diagnostic efficacy for predicting adverse outcomes in pre-eclamptic women with severe features presented at ≥ 34 weeks of gestation. Thus, from a health and financial perspective, employing reliable non-invasive simple techniques is warranted to reduce the impact of PE arise mainly from premature birth, neonatal complications and stay in neonatal intensive care unit (NICU). In limited resource settings as in Egypt, prevention of health burden related to PE represents a major challenge. These circulatory adaptations could be non-invasively detected by Doppler ultrasound waveforms. However, it is believed that the main feature is urtero-placental insufficiency with compensatory changes of fetal circulation in response to hypoxia. The pathogenesis of PE is quite complex and poorly understood. The latter accounts for the majority of cases (> 80%). īased on the onset, PE is further classified into two main types, early onset (EOP) and late onset (LOP) with cut-point of ≤ 34 weeks gestation. In Egypt, around 960 maternal deaths occur annually with PE identified as the main indirect cause of death.
In 2014, a multi cross- sectional survey conducted in 29 developing countries reported that a range of 1 in 10 to 1 in 4 perinatal deaths were attributed to severe PE and eclampsia. In low- and middle-income countries, the prevalence is rapidly increasing almost 7 times more (2.4%) than developed ones (0.4%). The worldwide-level estimates of PE range from 3 to 10% of all pregnancies with more than 70.000 maternal mortalities and over 500.000 fetal/neonatal deaths annually. It constitutes a major health problem associated with substantial maternal and perinatal morbidity and mortality with increased risk of long-term health consequences. Preeclampsia (PE) is a complex pregnancy-specific hypertensive disorder arising after 20 weeks’ gestation. In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome. In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52, 87 and 57%, respectively. Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79, 72.8 and 73.3%, respectively). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status ( p < 0.05). ResultsĪll UA indices were significantly higher in the case group compared to the controls ( p < 0.001). Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured. MethodsĪ prospective study was conducted among childbearing women who presented with severe LOP and matched controls. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality.
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