Pre-Eclampsia Clinical Trial
Official title:
The Efficacy of Fetal Arterial and Venous Doppler Indices in Predicting Perinatal Outcome Among Severely Hypertensive Pregnant Patients.
60 pregnant women with singleton living fetus between 34 -38 wks gestation known to have
severe hypertension in the current pregnancy were included.
All participants underwent Doppler ultrasonography to evaluate the Feto-Placental Circulation
within 24 hours from Pregnancy Termination.
Flow Velocity Waveforms were obtained from: Umbilical Artery (UA), Middle Cerebral Artery
(MCA), Ductus Venosus (DV), Umbilical Vein (UV).
From the flow velocity waveforms the following indices were measured:
UA & MCA: Pulsatility Index (PI) & Resistance Index (RI), DV: Peak Velocity Index For veins
(PVIV), Peak Systolic Velocity (PSV) & a- wave.
UV Flow: Presence or Absence of Pulsatile Flow.
60 pregnant women (aged from 18- 35 years) with singleton healthy living fetus between 34 -38
wks gestation known to have severe hypertension in the current pregnancy were included.
Chronic Hypertension was defined as a blood pressure value of 140/90 mm Hg or higher
diagnosed before 20 weeks' gestation or preconception. Gestational Hypertension was defined
as blood pressure value of 140/90 mm Hg or higher on 2 occasions at least 4 hours apart that
occurred after 20 weeks' gestation in a patient with previously normal blood pressure.
Preeclampsia was defined as blood pressure value of 140/90 mm Hg or higher on 2 occasions at
least 4 hours apart and proteinuria (Proteinuria is defined as the excretion of 300mg or more
of protein in a 24 hour urine collection or 1+ by The dipstick method) that occurred after 20
weeks' gestation in a patient with previously normal blood pressure. Chronic hypertension &
gestational hypertension was considered to be severe if systolic blood pressure ≥160 mmHg or
diastolic blood pressure ≥110 mmHg, or both & persists for 15 minutes or more. Preeclampsia
was considered to be severe in the following conditions: Blood pressure of 160/110 or more,
Thrombocytopenia (platelet count less than 1000,000 / microliter), impaired liver function
(elevated blood levels of liver transaminases to twice the normal concentration) , severe
persistent right upper quadrant or epigastric pain unresponsive to medication and not
accounted for by alternative diagnosis, or both, the new development of renal insufficiency
(elevated serum creatinine > 1.1mg/dL or a doubling of serum creatinine in the absence of
other renal disease) & new-onset cerebral or visual disturbances. Patients with other
maternal medical disorders rather than hypertension or experienced rupture of membrane or
antepartum hemorrhage (placenta previa or accidental hemorrhage) were excluded. Also,
patients who received respiratory depressants medications within 2 hours from the delivery of
the fetus (e. g., opioid analgesic) were excluded.
Informed consents were obtained from all participants after explanation of the study and its
aims. All participants underwent the following: Full history taking including a detailed
history of the hypertension state during the current pregnancy (onset, course, current
medication, and whether the blood pressure is controlled or not). complete physical
examination: general (including BMI & blood pressure measurement) and obstetric examinations.
Routine obstetric ultrasound: to confirm gestational age & fetal viability & number, assess
fetal weight (EFW) and growth percentile & amniotic fluid index (AFI) & to exclude fetal
anomalies. Laboratory investigations (Complete blood count (CBC) - Urine analysis for
albuminuria - Liver enzymes & kidney function). In addition to Doppler ultrasonography
assessment using GE Voluson Pro-V and GE Voluson E10 with 3.5-5 MHz abdominal transducer).
The color flow imaging (to identify the vessels) & pulsed wave velocimetry was used to obtain
flow velocity waveforms within 24 hours of pregnancy termination from: Umbilical artery (UA):
from a free-floating loop in the mid portion of the cord, Middle cerebral artery (MCA):
obtained from a transverse image of the fetal head at the level of sphenoid bones (color flow
im¬aging was used to display the circle of Willis), Ductus venosus (DV) was sampled soon
after its origin from the umbilical vein & finally Umbilical vein flow (UV) assessment. In
all Doppler studies, while the woman is lying in a semi-recumbent position, the angle of
insonation of the vessels is < 45 degrees & the high-pass filter is set at 100 Hz. Care is
taken not to exert undue pressure on the fetal head because this alters the flow velocity
waveforms from the MCA. Furthermore, examination of the fetal vessels was performed in the
absence of fetal body and respiratory movements, with a fetal heart rate ranging from 120-160
bpm. Measurements was obtained from ≥ 4 consecutive flow velocity waveforms of good quality
and averaged. From the flow velocity waveforms of the UA & MCA, the pulsatility index (PI) &
the resistance index (RI) was measured. From the flow velocity waveforms of the DV, peak
velocity index (PVIV), peak systolic velocity (PSV) and A wave was measured. From the
umbilical vein flow, the presence or absence of pulsatile flow was recorded. All labours was
attended by an expert neonatologist who was blinded to the results of Doppler indices
measurements & the following was recorded: APGAR score at (1 & 5 min) - Neonatal birth weight
(Fetal growth restriction will defined as birth weight of less than 10th percentile of
newborn weight in normal pregnancies at corresponding gestational age) - the occurrence of
respiratory complications [Transient Tachypnea of the newborn (TTN) or Respiratory Distress
Syndrome (RDS)] - The further need for neonatal intensive care unit (NICU) admission &
Perinatal death.
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