Fetal doppler ultrasound findings in preeclampitic women attending antenatal services at Muhimbili national hospital

Abstract

Background: Preeclampsia (PE) is among the leading causes of maternal and fetal morbidity and mortality. Developing countries are more affected, Tanzania being among them. We need more efforts to study this area in order to improve maternal and fetal wellbeing. Doppler Ultrasound to pregnant women attending maternity services was the screening method used. Objective: Fetal Doppler Ultrasound findings in Preeclamptic Women attending Antenatal Services at Muhimbili National Hospital. Material and Methods: Cross sectional hospital based study was conducted from July 2016 to December 2016 involving 143 pregnant women at MNH. The consented candidates from 20weeks of gestation to term were included in the study. Structured, close ended questionnaires were used to get patient information and fetal Grey scale and Duplex color Doppler ultrasound were used to obtain biophysical profiles and Doppler / indices. Results: The candidates were aged between 16 and 42years, with the mean age of 29years. Among them the majority were married 82.5%, primary education 54.5% and 44.1% were self-employed. Preeclampsia affected 15.4% of the candidates. The age group more affected was between 20-35years. The risks for preeclampsia were previous Preeclampsia 22.7%(P-value 0.002) and family history of hypertension 63.6%(P-value 0.0001). The history of previous abortion carries 31.8%(P-value 0.175) in patients with preeclampsia but not statistically significant. The results showed that, there were statistically significant alteration of Doppler indices in preeclampsia. The percentage shown below indicate the patients who showed a particular named alteration in Doppler studies: Umbilical artery pulsatility index(UAPI) 36.4%, Umbilical artery resistive index(UARI) 31.8%, Middle cerebral artery index(MCARI) 54.5%, MCA/UAPI 27.3%, MCA/UARI 31.8%.The low birth weight accounts 20% of the total births. There was statistically significance association between abnormal Doppler indices alteration and Low birth weight, UAPI,UARI,MCAPI and MCARI,in which the number of patients were 42.2%,42.9%,71.4% and 57.1% respectively( P-Value 0.0001) also MCAUAPI 32.1% and MCAUARI 35.7%.The Systolic/diastolic ratio( SD ratio) was increasing with gestational age. Among the Preeclampsia women studied 18.2% fetuses experienced Absent end diastolic velocity(AEDV) and 4.6% Reverse flow pattern, which indicates high level of hypoxia (placental insufficiency). These fetuses were born prematurely and all had low birth weight. Conclusion: The Prevalence of Preeclampsia was 15.4% among pregnant women attending MNH which is higher compared to other places. Factors related to Preeclampsia were previous preeclampsia and family history of preeclampsia. Umbilical artery Doppler indices were more affected than MCA indices in Preeclampsia, however alteration of MCA indices were much more related to low birth weight. Recommendation: Doppler Ultrasound Scanning should be one of the basic investigation in the antenatal care services, particularly in high risk pregnancies.