Umbilical artery doppler flow patterns in high-risk pregnancy and foetal outcome in Mulago Hospital.

Abstract

INTRODUCTION: High risk pregnancy health problem worldwide because it is associated with increased foetal and maternal morbidity and mortality. Umbilical artery Doppler ultrasoudnd can e used to monitor the baby by observing the flow in the umbilical arteries. The abnormal foetal umbilical artery flow patterns are decreased or absent end-diastolic flow or reversal of flow (RF). It is important for radiologists and obstetricians to know the normal and abnormal flow patterns for early intervention or to avoid unnecessary interventions. OBJECTIVE: The study aimed at demonstrating the flow patterns and associated factors in high-risk pregnancy at Mulago Hospital using Doppler ultrasound of the foetal umbilical artery. METHODOLOGY: A Cross-sectional descriptive study was done in mulago national referral hospital from December 2008 to April 2009. The target population was all high risk singleton pregnancy mothers attending the antenatal clinic or admitted in the obstetric wards. A low frequency probe for a sonoace 8000 machine by Medison (2001) was used. The foetuses were followed up until april 24 hours following delivery. Data for 192 patients was analyzed using STATA. RESULTS: The mother’s age range was 16 to 41 years. Twenty-one foetuses had abnormal flow patterns (12 had reduced end-diastolic flow, 8 had AEDF and 1 had RF). Seventy-six percent of the foetuses with abnormal flow patterns were born prematurely. Eleven of the 12 foetuses with reduced end-diastolic flow survived. Of the foetuses with AEDF, 3 survived but were admitted to the neonatal special care unit while 5 died (3 within 24 hours of delivery and 2 in utero). One foetus had RF and was a stillbirth. Eighteen foetuses were delivered after an obstetric intervention.

CONCLUSIONS AND RECOMMENDATIONS: The prevalence of abnormal flow patterns is 10.9%. Abnormal flow patterns, low biophysical profile score, premature delivery, low birth weight and low apgar score are related to adverse foetal outcome. Reduced end diastolic flow foetuses have better outcome. A low biophysical profile score is related to AEDF/RF. All high risk pregnancy mothers should undergo umbilical artery Doppler ultrasound scans and biophysical profile scores to detect foetal compromise early and reduce on perinatal mortality rate.