PREDICTIVE VALUE OF SCREENING UTERINE ARTERY DOPPLER ULTRASOUND FOR PRE-ECLAMPSIA IN HIGH RISK PREGNANCY

Abstract

Background: Pre-eclampsia is a pregnancy specific heterogenous systemic disorder, affecting both the mother and the foetus. Pre-eclampsia and intrauterine growth restriction remain important causes of maternal and perinatal morbidity and mortality. Sonography is a worldwide method of choice for non-invasive examination of pregnancy. Doppler velocimetry is a suitable non-invasive method for evaluation of pathological haemodynamic changes in uteroplacental circulation. Abnormal uterine artery waveforms especially pulsatility index, alone or combined with notching, is the most predictive Doppler index.

Objective: To determine the positive predictive value of Screening Doppler ultrasound in the detection of pre-eclampsia during the first and second trimesters in high risk pregnancies by taking 24 hours proteinuria as the gold standard.

Method: Total 350 patients of high risk group were examined at 11-14 weeks and 20-24 weeks of gestation. Color and pulse Doppler Ultrasound was performed trans-abdominally, serial longitudinal and transverse images were assessed on GE Voluson with a convex probe. Pulsatility index >1.1 was considered abnormal. Sensitivity, specificity, PPV, NPP, and diagnostic accuracy were calculated taking 24 hours proteinurea as gold standard. The data were analyzed using SPSS.

Results: Age distribution of the patients was done which shows majority of the patients between 20-45 years i.e. 33.43% (n=117); mean and SD was calculated as 28.98(5.32 years, frequency of pre-eclampsia on 24 hours proteinuria (gold standard) was recorded in 8.29% (n=29), diagnostic accuracy of Doppler Ultrasound for the prediction of pre-eclampsia (taking 24 hours proteinuria as gold standard) revealed 7.14% (n=25) true positive, 1.71% (n=6) false positive, 90% (n=315) true negative and 1.14% (n=4) had false negative, while 86.21% sensitivity, 98.13% specificity, 80.65% positive predictive value, 98.75% negative predictive and diagnostic accuracy was recorded in 97.14% of the patients.

Conclusion: The results of the study revealed a significantly higher positive productive value of Doppler ultrasound in the detection of pre-eclampsia during the first and second trimester in high risk pregnancy by taking 24 hours proteinuria as gold standard.