• The value of ultrasound and Doppler exams after 22 weeks of gestation for the diagnosis of obstetric and perinatal pathology in low3risk pregnancy

The value of ultrasound and Doppler exams after 22 weeks of gestation for the diagnosis of obstetric and perinatal pathology in low3risk pregnancy

PERINATOLOGIYA I PEDIATRIYA.2016.1(65):81-87;doi 10.15574/PP.2016.65.81

The value of ultrasound and Doppler exams after 22 weeks of gestation for the diagnosis of obstetric and perinatal pathology in low3risk pregnancy

Safonova I. M. 
Kharkiv medical academy of postgraduate education, Kharkiv, Ukraine

Purpose — determining the importance of sonographic and Doppler examination after 22 weeks of gestation for the diagnosis of obstetric and perinatal complications at pregnancy low risk.

Patients and methods. 4580 pregnant women from low risk subpopulation with normal results of ultrasound screenings. After 22 weeks of gestation sonographic and Doppler studies of pregnancy were performed. Perinatal outcomes of were studied as well.

Results. The incidence of pathological ultrasound changes after 22 weeks of gestation in women at low risk subpopulations was 9.8%. Сritical placental violations were found in 51/4580 women (1.13%). In early fetal growth retardation cases at 26–30 weeks of gestation (44/51 or 86.2%) the outcomes of pregnancies were unfavorable. In 83.9% cases of placental noncritical violations there were clinically favorable perinatal outcomes. In isolated polyhydramnios favorable outcomes were observed in 61.3% of cases. The risk of intrapartum distress after normal results of the III trimester ultrasound was high: OR 25 (95% CI 29–21), RR 83 (95% CI 77–88). The risk of premature rupture of membranes at normal results of the III trimester ultrasound was also high: OR 35 (95% CI 41–29), RR 88 (95% CI 94–80). Despite the low overall rate (2.5%) of identify of uterine artery Doppler changes more than half of women with such disorders had perinatally significant complications which were observed later. An important predictor of preeclampsia and perinatal complications in low-risk pregnancy can be considered a bilateral abnormal uterine artery Doppler in conjunction with early calcification of the placenta: OR 300 (95% CI 278–335), RR 75 (95% CI 71–79).

Conclusions. Features revealed by US in the second half of low-risk pregnancy in 3.2% of cases «translate» low'risk pregnancy into the high'risk, and in 6.6% — into the indefinite risk pregnancy. Medical tactics changed less than in 1% of the cases on the basis of ultrasound after 22 weeks of gestation in women at low-risk pregnancy. However, the value of third trimester ultrasound study is forecasting of negative or ambiguous outcome of pregnancy, direction at perinatal center, routine examination and treatment of newborns. Based on this analysis the inclusion of ultrasound scan at 26'30 weeks of gestation into antenatal care protocols may be considered reasonable.

Key words: high risk pregnancy, ultrasound, perinatal outcome.

REFERENCES

1. Metodychni rekomendatsii shchodo orhanizatsii nadannia ambulatornoi akushersko-hinekolohichnoi dopomohy: nakaz MOZ Ukrainy № 417. Kyiv, 2011: 100.

2. Natsionalni pidkhody do vprovadzhennia systemy rehionalizatsii perynatalnoi dopomohy v Ukraini (praktychni nastanovy). Daidzhest profesiinoi medychnoi informatsii. 2012. 48—49: 1—59.

3. O sovershenstvovanii prenatalnoy diagnostiki v profilaktike nasledstvennyih i vrozhdennyih zabolevaniy u detey: prikaz Ministerstva zdravoohraneniya Rossiyskoy Federatsii ot 28.12.2010 g. № 457.

4. Safonova IN, Lukyanova IS. 2013. Evidence-based medicine, 3rd routine ultrasound scanand fetoplacental pathology, identified in the last trimester of pregnancy (review of litera-ture and Web sources). Health of woman. 3(79): 56—61.

5. Safonova IN. 2015. Znachenie ehograficheskih issledovaniy posle 22 nedel gestatsii dlya diagnostiki fetalnoy patologii i prognozirovaniya perinatalnogo rezultata pri beremennosti nizkogo riska akusherskih i perinatalnyih oslozhneniy. Ukrayinskiy radiologichniy zhurnal. XXV; 4: 20—29.

6. Alfirevic Z, Stampalija T, Gyte GM. 2010. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev. 8. http://dx.doi.org/10.1002/14651858.cd001450.pub3

7. Bricker L, Neilson JP, Dowswell T. 2009. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev: CD001451.

8. Callen PW. 2011. Ultrasonography in Obstetrics and Gynecology. Elsevier Health Sciences: 1180.

9. Dias T, Ruwanpura L. 2011. Systematic introduction of obstetric ultrasound skills into practice. Sri Lanka JOG. 33: 154—157.

10. ISUOG Practice Guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol. 2013. 41: 233—239. http://dx.doi.org/10.1002/uog.12371; PMid:23371348

11. Moore TR, Cayle JE. 1990. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol. 162(5): 1168—1173. http://dx.doi.org/10.1016/0002-9378(90)90009-V

12. Safonova I. 2014. Fetal brain anomalies assotiated with intrauterine neuroinfection and fetal distress and their potnatal results. Ultrasound Obstetrics and Gynecology. 44(1): 101.

13. Poon LCY, Volpe N, Muto B et al. 2013. Second-Trimester Uterine Artery Doppler in the Prediction of Stillbirths. Fetal Diagn Ther. 33: 28—35. http://dx.doi.org/10.1159/000342109; PMid:22947667

14. Leona C.Y. Poon, Nicola Volpe, Brunella Muto et al. 2013. Second-Trimester Uterine Artery Doppler in the Prediction of Stillbirths. Fetal Diagn Ther. 33: 28—35. http://dx.doi.org/10.1159/000342109; PMid:22947667

15. Signore C, Freeman RK, Spong CY. 2009. Antenatal Testing — A Reevaluation. Obstet Gynecol. 113(3): 687—701. http://dx.doi.org/10.1097/AOG.0b013e318197bd8a; PMid:19300336 PMCid:PMC2771454

16. Wyldes MP, Tonks AM. 2007. Termination of pregnancy for fetal anomaly: a populationbased study 1995 to 2004. BJOG. 114: 639—642. http://dx.doi.org/10.1111/j.1471-0528.2007.01279.x; PMid:17355269

Содержание журнала Full text of article