Fetal umbilical artery doppler ultrasound findings in pregnant women with chronic illnesses attending antenatal services at Muhimbili national hospital

Abstract

ABSTRACT Background: Chronic illnesses in pregnancy are increasing, with the incidence in Germany at 21.3%, India at 10.6%, and Africa at 24.3%, which affects both maternal and fetal health. These conditions cause poor placenta formation with placenta hemodynamic disturbance, fetal complications of low birth weight, congenital malformations and low Apgar score. This study uses grayscale and umbilical artery Doppler ultrasound to evaluate fetal well-being in pregnant women with chronic illnesses. Objective: To evaluate the estimated fetal weight, umbilical artery Doppler, and other grayscale findings among pregnant women with chronic illnesses from September 2023 to March 2024 Methodology: A 7-month hospital-based study enrolled 155 pregnant women with chronic medical conditions. Data was collected through structured questionnaires of maternal clinic information, grayscale and Duplex color Doppler ultrasounds. Fetal growth restriction was identified at estimated fetal weight( EFW )< 10th percentile and abnormal umbilical artery indices values at > 95th percentile. Fisher’s exact test was used to evaluate the association of the variables, together with multivariate analysis to determine the independent factor under the outcome of interest in this study. Results: The study enrolled 155 pregnant women with a median age of the participants of 34 years, IQR ( 31–37 )years. The majority of them were married (82.6%) and about 50.3% had acquired a secondary school education. The key factor strongly associated with intrauterine growth restriction (EFW<10th percentile) is the abnormal pulsatility index (adjusted odds ratio(AOR)=20.35, 95% CI: 6.03–68.66, P<0.001*). On the other hand, reversed end-diastolic flow (REDF) and chronic hypertension were independent predictors of intrauterine growth restriction(IUGR) at AOR = 3.56, 95% CI: 1.38–9.18, P<0.001*) for chronic hypertension. Conclusion: Reversed end-diastolic flow (REDF) is a strong sonographic predictor of IUGR and chronic hypertension has been shown to increase the risk threefold in our cohort