![]() This prospective cohort study was conducted from January 2005 to December 2006. This study was designed to emphasize the effect of Doppler ultrasound on high-risk pregnancies in regard to obstetrical management as well as fetal, prenatal, and neonatal outcome. The hypothesis that Doppler is effective in reducing mortality and major morbidity in high-risk pregnancy could only be tested with a massive randomized trial. Doppler assessment may lead to intervention that reduces the risk of fetal brain damage. On the basis of abnormal Doppler results, obstetrical decision making 3 might improve and prevent intrauterine death because hypoxic cerebral damage may begin before labor 4 and intrapartum asphyxia is probably more damaging when superimposed on underlying hypoxia. ![]() It was postulated that Doppler ultrasound would be a useful addition to our catalog of tests of antenatal fetal well-being and timely intervention. Doppler investigation of middle cerebral artery in combination with umbilical artery seems to improve prediction of adverse outcome in near-term pregnancies. The majority of adverse perinatal outcomes in developing countries are placental-associated diseases and it is confirmed that uterine Doppler evaluation predicts most occurrences of early-onset preeclampsia and intrauterine growth restriction, and its use in these pregnancies improves a number of perinatal outcomes. Primarily it appeared that abnormalities in ductus venosus waveform were the endpoint for pregnancies distressed with intrauterine growth restriction contrary to newer data proposing these abnormalities as plateau prior to further fetal deterioration as observed by changes in the biophysical profile. ![]() Recent findings aided in timing delivery of severely growth-restricted fetuses by promoting the use of ductus venosus Doppler. A combination of several Doppler parameters was superior to a single parameter, although the parameters were strongly correlated with each other.The significance of Doppler ultrasound in evaluating pregnancies that have the risk for preeclampsia, intrauterine growth restriction, fetal anaemia, and umbilical cord abnormalities has become indispensable. In conclusion, pathological Doppler velocimetry of the uterine and uteroplacental circulation was a powerful predictor of PPIH and/or IUGR in high-risk pregnancies, identifying a group in which 58.3% would suffer from disease later in pregnancy. ![]() None of the patients showed bilateral notching. Here PPIH and/or IUGR was seen in 6.1-6.4% in the group with abnormal Doppler findings compared to 5.2% in pregnancies with normal findings. However, Doppler was less powerful in the population at low risk. However, the combination of all parameters was superior to a single parameter, and a bilateral notch was superior to a unilateral notch in terms of minimizing false-positive results. The criterion for the definition of pathological Doppler results, whether persistent notching, the resistance index (RI) of the main stem uterine artery, or the RI in the arteries of the uteroplacental bed, was of minor importance, as all Doppler parameters were strongly correlated. In this group PPIH and/or IUGR was found in 58.3%, compared to 8.3% if Doppler results were normal. In the high-risk group a single pathological Doppler sign accounted for an additional three- to four-fold increased risk, and the combination of all three pathological signs, a seven-fold additional risk for later disease. Doppler proved to be more efficient at predicting a complicated pregnancy in those patients who were at high risk: a positive medical history alone was associated with a three-fold greater risk of developing PPIH and/or IUGR. The incidence of proteinuric pregnancy-induced hypertension (PPIH) and intrauterine growth retardation (IUGR) were recorded as main outcome measures. Persistent notches in the main stem uterine arteries and elevated resistance indices of > 0.68 in the uterine arteries and > 0.38 in the uteroplacental arteries were defined as abnormal waveforms. Using duplex pulsed wave Doppler ultrasound, we recorded blood velocity waveforms from both main uterine arteries, the uteroplacental arteries in the region of placental implantation and the umbilical artery at 21-24 weeks of gestation. During a 20-month period we studied 175 pregnant women at high risk for hypertensive disorders of pregnancy or intrauterine growth retardation, and 172 patients at low risk, in a prospectively designed cross-sectional trial.
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