A Study on Color Doppler and Non Stress Test as Predictor of Perinatal Outcome in Pregnancy Induced Hypertension and Intrauterine Growth Restriction in a Tertiary Care Hospital in Eastern India
Keywords:Antepartum fetal surveillance, color doppler studies, non- stress test, preeclampsia, intra uterine growth restriction.
Introduction: Antepartum surveillance to evaluate fetal health have been the focus of intense interest for more than decades. The timely detection of morbid changes in fetal status followed by adequate interventions to avoid death or disabilities, is of paramount importance.
Objective: To compare the effectiveness of non-stress test and color doppler studies in the prediction of perinatal outcome in terms of mode of delivery , gestational age at delivery, birth weight , admission in neonatal intensive care unit (NICU), fetal morbidity and mortality.
Material & Methods: A prospective observational study was conducted among (n=100) antenatal patients admitted in the obstetric indoor of a hospital in Kolkata, West Bengal complicated by pre eclampsia and intra uterine growth retardation (IUGR) beyond 34 weeks of gestation after matching with inclusion and exclusion criteria. Recruited participants were then divided into four groups: group A having both tests normal, group B with normal NST and abnormal doppler, group C with normal doppler and abnormal NST and group D with both abnormal tests respectively. The patients were followed by serial fetal doppler assessment and non- stress test (NST). The results of the last doppler and NST within one week of delivery were considered in the subsequent correlation with perinatal outcome. The time interval in days between the first abnormal doppler and the development of abnormal NST was used to calculate the lead time. The perinatal outcome parameters studied were mode of delivery, gestational age at delivery, birth weight, neonatal morbidity in terms of Apgar score < 7 at 5 minutes, NICU stay, and perinatal mortality. The major adverse perinatal outcomes, if any was observed amongst the four study groups.
Results: 40% percent of multigravidas had a history of preeclampsia in their previous pregnancy. 18% of the study population had a combination of preeclampsia and IUGR. 38 women had both NST and doppler study normal (Group A) while both tests were abnormal in 31 patients (Group D).There were 54 women with abnormal doppler findings and 39 with abnormal NST. Brain sparing effect (BSE) was seen in 38 women. Group A had majority of cases (65.78%; 25 out of 38) with only IUGR and had the least morbidity and best perinatal outcome. Group D had the maximum number of cases having combined preeclampsia with IUGR (70.96%; 22 out of 31) and had the worst perinatal outcome associated with prematurity and low birth weight; there were only 15.78% NICU admission in the group A; in contrast 77.4% fetuses required NICU admission in group D. Only 39.4% had operative delivery for fetal distress in group A in contrast to 70.96% women in group D. There were 4 intra uterine and 13 neonatal deaths. Majority of fetuses showed abnormal doppler changes prior to NST. The lead time varied between 0-9 days with a mean of 4.11 days.Conclusion: Though both test results were effective in predicting abnormal perinatal outcome, a significant advantage of doppler over NST was it showed abnormal changes earlier than NST giving a significant lead time of up to 9 days which is important in the management of preterm high -risk pregnancies. An abnormal NST following an abnormal doppler is associated with the worst perinatal outcome. Both the tests are complimentary to one another in fetal surveillance of high -risk pregnancies.
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Copyright (c) 2022 Apurba Mandal, Kajal Kumar Patra, Shibram Chattopadhyay, Tanushree Roy, Arunava Biswas, Tanmay Mandal
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