Comparative Study of Uterine and Umbilical Artery Doppler and Pregnancy Risk Status in Predicting Adverse Pregnancy Outcome

Abstract

Background: The rising rate of adverse pregnancy outcomes, particularly in low-and middle-income countries, calls for simple, accurate diagnostic tools to avert the associated high morbidity and mortality. Objective: To determine the relationship of uterine/umbilical Doppler ultrasound with adverse pregnancy outcomes and high-risk pregnancies (HRP). To compare the predictive efficacy of uteroplacental versus pregnancy risk status in predicting adverse pregnancy outcomes. Materials and Methods:  This was a comparative longitudinal study of the uterine and umbilical Doppler and pregnancy outcomes among cohorts of HRP and normal pregnancies (NPs). The data was analyzed by IBM SPSS version 23.0. The student t-test and Chi-square tested association Doppler parameters and; adverse pregnancy outcomes and pregnancy outcomes. Multiple regression analysis assessed the best predictor of adverse pregnancy outcomes. P values <0.05 were statistically significant. Results: Uterine end-diastolic volume (EDV) was 15.9±8.59cm/s and 29.8± 15.9cm/s (p=0.014), whilst umbilical EDV=19.1±8.59cm/s and 35.2±13.6cm/s (p=0.016) in adverse pregnancy outcome and normal outcome cases respectively. Uterine artery resistance index (RI=0.57 ± 0.14), pulsatility index (PI=1.23 ± 0.68) and S/D ratio (S/D=2.56 ± 0.97). Similar Doppler parameters of low EDV and high RI, PI, and S/D were recorded in women with adverse pregnancy outcomes in the umbilical arteries. In HRP, the uterine and umbilical artery PI, RI, and S/D were higher than in NPs (P-value<0.05). The uterine PI independently predicted adverse pregnancy outcome in 76.5 % (AUC 95% CI: 0.693; 0.837, p<0.001). While the combination of uterine PI and HRP status predicted adverse pregnancy outcomes in 80.1% (AUC 95% CI: 0.735; 0.867, p<0.001). Conclusion: High Doppler impedance to blood flow and low diastolic flow occur in both uterine and umbilical arteries, in pregnancies with adverse outcomes and high-risk pregnancies. Uterine PI independently predicts adverse outcomes in pregnancy.