O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 12 O&G Forum 2021; 31: 11 - 14 ORIGINAL RESEARCH 2020 in two normal and high-risk groups (essential hypertension, gestational HTN, and GDM) after obtaining voluntarily informed consent entered the study (None had fetal abnormalities). These patients underwent Doppler ultrasound, their CPR index was measured and then followed up prospectively until delivery. Their neonatal (preterm birth, 5 minutes Apgar less than 7, the need for a ventilator, NICU admission) and obstetrical (emergency cesarean delivery due to fetal distress) outcomes were registered. The results of the umbilical artery flow measure (UA) were obtained by placing the sample volume in the lumen of the artery away from the placental and umbilical cord insertion. After recording the technically satisfactory Doppler waveform, the pulsatility index (PI) was obtained. The results of the middle cerebral artery were obtained on the cross-section of the fetal head at the level of the thalami and the cavum waveform, and then the pulsatility index was calculated. CPR is calculated by dividing the middle cerebral artery pulsatility index (PI) by the umbilical artery PI. Statically analysis All statistical analyses were conducted by SSPS Version 19 (SPSS Inc., Chicago, IL, USA), and a p-value <0.05% was considered statistically significant. Number and percentage are represented the qualitative variables and mean ±SD displayed the quantitative variables. Continuous variables of two groups were compared using independent samples t-test, while qualitative variables were analyzed using chi-square or Fisher’s exact test. Predictive values were showed with a 95 % confidence interval. Results As shown in Table 1, there was no statistically significant difference between the two study groups in terms of parity and pregnancy and the timing of Doppler ultrasound. Gestational age at delivery was significantly higher in the control group than in the case group. In terms of Doppler ultrasound parameters, there was a significant difference between the two groups. The umbilical artery (UA) PI was significantly smaller in the control group than the case group, while the middle cerebral artery (MCA) PI and cerebroplacental ratio (CPR) were higher in the control group. Table 1. Demographic and ultrasound parameters characteristics of the patients Variable Control group (n = 34) Case group (n = 34) P-value Parity n (%) 0 16 (47.1) 18 (52.9) 0.882 a 1-2 16 (47.1) 14 (41.1) >=3 2 (5.8) 2 (5.8) Gravid n (%) 1 14 (41.1) 14 (41.1) 0.917 a 2-3 16 (47.1) 17 (50.0 >=4 4 (11.8) 3 (8.8) Gestational age Doppler (week),M ± SD 33.5 ± 1.2 33.0 ± 1.5 0.131 a Gestational age, M ± SD 38.7 ± 1.6 37.1 ± 2.6 0.003 b UA PI, M ± SD 0.9 ± 0.2 1.0 ± 0.2 0.013 b MCA PI, M ± SD 1.7 ± 0.2 1.4 ± 0.3 <0.001 b CPR PI, M ± SD 1.9 ± 0.3 1.5 ± 0.4 <0.001 b Abbreviations: n: number, M: Mean, SD: standard deviation, a: chi2, b: t-test, PI: pulsatility index, UA: umbilical artery, MCA: middle cerebral artery, CPR: cerebroplacental ratio As shown in the table, except for the umbilical artery coefficient, two other parameters are significantly different between the two groups. Table 2. comparison color Doppler categorize parameters of the patients in the two study groups Parameter Control group (n = 34) Case group (n = 34) P-value (chi2) UA PI n (%) ≤ 1.42 34 (100.0) 32 (94.2) 0.151 >1.42 0 (00.0) 2 (5.8) >=3 2 (5.8) 2 (5.8) MCA PI n (%) <1.5 3 (9.1) 16 (47.1) 0.001 ≥ 1.5 31 (90.9) 18 (52.9) CPR n (%) <1 2 (5.8) 10 (29.4) 0.011 >1 32 (94.2) 24 (70.6) Table 3. Outcomes and frequency of complications in the two study groups Variable Control group (n = 34) Case group (n = 34) P-value a Stillbirth 0 0 1.000 The need for a ventilator 1 4 0.356 NICU admission 4 17 <0.001 Preterm birth 3 10 0.031 Caesarian section (emergency) 7 13 0.110 5 min Apgar score (5-7) 0 2 0.493 Note: n: number, PI: pulsatility index, UA: umbilical artery, MCA: middle cerebral artery, CPR: cerebroplacental ratio Note: a: chi2 or fisher exact test In terms of pregnancy complications, neither group had any stillbirths. In general, pregnancy complications were higher in the case group than the control group, in which the preterm birth and the need for hospitalization in the intensive care unit showed a significant difference with the control group. According to the information presented in Table 4, if CPR PI is <1, approximately 95% of patients may suffer from major complications of pregnancy, and more than this amount, approximately 83% do not suffer from these complications. If the MCA PI is <1.5, approximately 86% of patients may develop pregnancy complications, and more than this amount, approximately 68% do not develop these complications. According to the information provided in Table 5, if the CPR PI is <1, approximately 94% of patients may have pregnancy complications, and less than this amount, approximately 83% will not have these complications. If the MCA is <1.5, approximately 88% of patients may experience pregnancy complications, and less than this amount, approximately 81% do not develop these complications.