Umbilical Artery Doppler Velocimetry as a predictor of perinatal outcome among antenatal women with high-risk pregnancies in Jos, Nigeria.

Abstract

Background: Perinatal morbidity is a huge burden globally, with greater impact in the developing countries. Umbilical artery Doppler velocimetry as an antenatal surveillance tool significantly reduces perinatal morbidity and mortality among high-risk pregnancies, especially those complicated with IUGR.

Objective: To determine the association between abnormal umbilical artery Doppler velocimetry and perinatal outcome in high-risk pregnancies.

Design: It was a Hospital based prospective cohort study.

Methodology: The study participants were 161 consenting pregnant women with high-risk pregnancies between 28 weeks and 38 weeks of gestation admitted into the antenatal ward of Jos University Teaching Hospital between 1^st February, 2021 and 31^st January, 2022. Data on socio demographic characteristics, obstetric history, gestational age, LMP, previous history of contraceptive use, irregular menstrual periods, and co-morbidities were obtained. Ultrasound scan was performed using a 3.5MHz convex probe of GE Voluson P8 4D ultrasound machine. The fetal biometric parameters were measured in 2D mode before the Doppler mode was activated for the velocimetry of the umbilical artery. Reduced end diastolic flow was measured as raised pulsatility index (PI) and resistive index (RI) above the 95^th percentile. This procedure was repeated two weekly or more frequently depending on the abnormality noted. They were then followed up till delivery to determine the fetal outcome. Analysis was done using SPSS software version 20.

Results: The prevalence of high-risk pregnancy was 41.2%. Hypertensive disorders accounted for 53.4% (86) of the study participants. Abnormal umbilical artery waveform pattern was found in 17.4%. The prevalence of IUGR among the study population was 14.9% (24). There were 95.7% (154) live births and 7(4.3%) stillbirths. There was statistically significant association between abnormal umbilical artery velocimetry and IUGR, preterm delivery, stillbirth, low birth weight, low APGAR scores at 5th minute and need for SCBU admission.

Conclusion: Umbilical artery Doppler study is a useful tool for antenatal surveillance in high-risk pregnancy. It is significantly associated with poor perinatal outcomes like IUGR, Preterm delivery, stillbirth, low birth weight, low APGAR scores at 5^th minute and need for SCBU admission. The poorer the Doppler indices, the worst the perinatal outcome.

Key Words: Umbilical artery, Doppler velocimetry, High-risk pregnancy, Fetal Surveillance

Key Message: Abnormal umbilical artery Doppler study is significantly associated with poor perinatal outcomes like IUGR, preterm delivery, stillbirth, low birth weight, low APGAR scores at 5th minute and need for SCBU admission.