Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Background: To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia. Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualized and cerebroumblical PI ratio calculated. MCA-RI<2SD was taken as abnormal. Adverse perinatal outcome was taken as major if there was stillbirth, immediate neonatal death, need of respiratory support and minor if neonatal nursery admission was done. Presence of acute fetal distress in labour was also noted. Results: There were 107 women in the study. Major adverse outcomes were 11. Umbilical artery-S/D ratio>2SD (RR 4.46, 95% CI 1.40-14.17) and RI>2SD (RR 3.36, 95% CI 1.03-10.61) and MCA RI<2SD (RR 4.46, 95% CI1.4-14.17) had a high relative risk to predict adverse major perinatal outcome. 39 babies were admitted in neonatal nursery and no parameters could predict them. Though UA-PI>2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis. Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.