The role of multiple vessel doppler ultrasound in predicting neonatal outcome in pregnancy induced hypertension

Background: Hypertensive disorders are among the commonest medical disorders during pregnancy and continue to be a major cause of maternal and perinatal morbidity and mortality.Methods: In this study total 100 cases and their doppler findings were recorded, Cases of PIH between 20 - 36 weeks of gestation in 2 years with B.P ≥140/90 mm hg and protienuria ≥1+ in this prospective analytical study investigations and color doppler scanner for studying uterine, umbilical PI, RI and fetal middle cerebral arteries as the indicator to evaluate perinatal outcome.Results: Increase incidence of low birth weight (less than 2.5) observed in group of umbilical and uterine PI was (>1.5,>1 respectively)67% and 83%. Apgar score at 5 minutes 0.7, >0.6respectively) newborn delivered with weight less than 2.5 kg 76% and 80%, Apgar score at 5 minutes <7 33% and 80%, NICU admission 46% and 50%, perinatal mortality 60%and 42% more than that of with group of low RI. High rate of incidence seen where MCA PI < 1.3,90% newborns less than 2.5 kg birth weight,70% poor Apgar score at 5 minutes. abnormal ductus venosus group shows birth weight <2.5 kg 83%, Apgar at 5 minutes < 7 were 81%, NICU admission were 39%and perinatal mortalities 78% higher than normal ductus venosus group.Conclusions: The sensitivity of the Doppler significantly increased by studying multiple vessels (91.6%) of in the fetoplacental circulation. It would predict early compromise of blood supply to the fetus at the stage when the fetus is still not compromised and if timely measures are taken it helps in improvement of perinatal out-come

The prediction of pregnancy induced hypertension from umbilical and uterine Doppler flow study

Background: Hypertensive disorder along with hemorrhage and infection contribute greatly to maternal mortality and morbidity. Pregnancy induced hypertension remains among the most significant and intriguing unsolved problems in obstetrics.Methods: In this prospective analytical study investigations and color doppler findings 0f umbilical artery PI, RI and end diastolic flow in same, uterine PI, RI and persistent diastolic notch in uterine artery recorded. Total 100 Cases of PIH between 20-36 weeks of gestation in 2 years with B.P ≥ 140/90 mm hg and protienuria ≥ 1+ were observed.Results: In this study, out of 100 cases, there were 58 cases of mild PIH (58%) and 42 cases of severe PIH (42%). Umbilical artery PI was elevated in 43(43.0%) patients and was normal in  57(57.0%) patients. Umbilical  artery RI was more than and equal to 0.7 in 77 patients  (77%) and was below of 0.7 in 23 (23%) pa-tients.9(9.0%)  fetuses showed  absence  and  14 (14.0%) fetus  had  reversal and 46 (46.0%) had reduced  end diastolic umbilical artery flow with total 69 out of 100  fetuses  having  abnormal  waveforms.65 (65%)  mothers  had  an  elevated  uterine  artery  PI   and  35(35%)  patients   had  normal uterine  artery PI. in observation 69 (69%)  patients  were  having  RI more  than 0.6, while 31 (31%) were having less than 0.6 out of 100 patients. In this study, 65 (65.0%) women were having persistent diastolic notch.Conclusions: This study was to evaluate arterial flow velocities as a predictor of impending pregnancy induced hypertension with raised RI and PI along with umbilical ab-sent or reverse end diastolic flow velocities and elevated RI and PI in the presence of a diastolic notch are considered as abnormal uterine doppler findings doppler finding with unfavorable outcome

Correlation between changes in placental morphological features with abnormal Doppler flow in pregnancy induced hypertension

Background: Placenta is one of the most challenging organs; it is an instrument of transfer of essential elements, i.e. nutrients and oxygen from mother to fetus and waste product of metabolism in reverse manner.Methods: Cases of PIH between 20-36 weeks of gestation will be studied over a peri-od of 2 years having B.P ≥140/90mm Hg and protienuria ≥1+ in this prospective analytical study having color Doppler scanner with PI, RI of umbilical, uterine artery and middle cerebral artery PI along with placental morphological changes are observed.Results: In present study where, placental weight was 1 group. While 78% placental infarction, 57% calcification and 69% retroplacental clots be-longed to uterine artery RI > 0.6 group. Infarction were 77.50%, calcification were same as infarction 77.50% while retroplacental clots 80% in group having MCA PI 1.3.Conclusions: In recent years placenta has drawn attention as valuable indicator for maternal and fetal diseases in preeclampsia. Decreased circulation in placenta reflects on its morphological features and these changes causes alterations in Doppler flow velocities of uterine, umbilical and middle cerebral vessels pregnancy induced hyper-tension

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension.Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period.Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h.Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure