Could Usg Doppler Be The New Prenatal Apgar? - Emerging Towards An Era Of Non Invasive Methods To Assess Hypoxia And Acidosis In High Risk Pregnancy

Background: Fetal distress is the acidotic and hypoxic condition of the fetus in late intrauterine life and immediate postnatal life. In antenatal assessment, Doppler ultrasound has been immensely helpful to know the condition of the fetus specifically in the late trimester. In high-risk pregnancies, current recommendations encourage the use of uterine artery Doppler for screening and Doppler of the umbilical artery, middle cerebral artery, and ductus venosus for monitoring and timing the birth. Fetal distress can be assessed in the immediate postnatal life through cord blood sampling. Thus, fetal distress can be assessed through Doppler ultrasound in the antenatal period and cord blood readings in the immediate postnatal life. Aims and Objective: To investigate how color doppler ultrasound can be used to evaluate high-risk third-trimester pregnancies and forecast neonatal outcomes. To anticipate the degree of hypoxemia by correlating Doppler results in the uterine and umbilical arteries with umbilical cord blood gas analyses. Method:From 2020 onward, patients referred to the Department of Radiodiagnosis and Imaging at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar were included in the study  with high-risk pregnancy taking into account all the inclusion and exclusion criteria. Doppler ultrasonography was then performed on all of these patients. Umbilical artery Doppler was evaluated on a free loop of the umbilical cord. For MCA (middle cerebral artery) Doppler indices axial view of the fetal head were taken. For Uterine artery evaluation, the probe was placed on the lower quadrant of the abdomen, angled medially, and Color Doppler imaging was used to identify the uterine artery at the apparent crossover with the external iliac artery. Mean Uterine artery‐ Pulsatility Index average PI (Pulsatility Index) of right and left arteries, and values above the 95th centile were defined as abnormal.We got data in the form of PI (Pulsatility Index), RI (Resistive index), and PSV (Peak Systolic Velocity). The data was collected from all three arteries. The outcome of the delivery was noted in the form of APGAR score. Cord blood was taken to analyze umbilical acid-base parameters. Cord blood needs to be assessed immediately within 30 minutes after taking the sample. It was collected in a syringe with a heparin washout. Approximately 2cc of blood was drawn out. The sample was processed and the parameters obtained were PO2, PH, PCO2, lactate, and base excess. Results: The mean value of maternal age (years) of study subjects was 30.22 ± 4.7. The majority [108](73.47%) of patients were primigravida. The mean value of gestational age (weeks) of study subjects was 36.86 ± 1.74. In the majority [97](65.99%)of patients, the high-risk risk pregnancy factor was IUGR followed by maternal anemia [88](59.86%), gestational hypertension [86](58.50%) and preeclampsia [80](54.42%).The mean value of the pulsatility index and resistive index of study subjects was 1.61 ± 0.97 and 0.95 ± 0.5. The mean value of the pulsatility index and resistive index of the middle cerebral artery and uterine artry ± 0.09 1.28 ± 0.13 and 0.68 ± 0.08 and 0.65 ± 0.09. The mean value of 5 minutes APGAR score of study patients and PH, base excess, Pco2 (mmHG), and pO2 (mmHG) was 9.5 ± 1.  The mean value of pH, base excess, pCO2(mmHg), and pO2(mmHg) of study patients was 7.23 ± 0.2, 3.51 ± 2.36, 42.65 ± 10.21, and 15.24 ± 1.8 .Reversal/absent flow was present in only 20 out of 147 patients (13.61%). In the majority of the patients, the uterine artery plasticity index was abnormal accounting for nearly 56.46 % (83). A significant association was seen in pH, pCO2(mmHg), pO2(mmHg), and base excess with uterine artery pulsatility index and reversal/ absent flow. Cerebroplacental ratio with a 5-minute APGAR score and pH were shown to be significantly positively correlated. Moderate agreement exists between pH and cerebroplacental and reversal/ absent ratio and uterine artery. Moderate agreement exists between pH and uterine artery PI.Good agreement exists between 5 minute APGAR score and cerebroplacental ratio . Conclusion: Abnormal Cerebroplacental ratio (CPR) shows a significant correlation with APGAR score and Cord Blood Gas. Absent and reversed end diastolic flow on umbilical Doppler shows the highest association with cord blood gas parameters and APGAR score. Abnormal uterine artery Doppler in the form of mean uterine artery Pulsatility Index > 95 percentile shows a positive correlation with Cord blood acidosis and APGAR score.