kk.pptx 1 trimester uterine artery doppler correaltion

uterine artery doppler

1. Title of Thesis Correlation of first Trimester Uterine Artery Doppler With Obstetric outcomes

2. Name of Guide - Dr. Savita Singhal Senior Professor, Unit head Department of Obstetrics and Gynaecology PGIMS ,Rohtak Name of Co-Guide - Dr. Menka Verma Associate professor Department of Obstetrics and Gynaecology PGIMS ,Rohtak Name of Candidate – Dr. Radhika Garg Postgraduate student Department of Obstetrics and Gynaecology PGIMS ,Rohtak

3. Introduction Uterine Artery Doppler is a specific ultrasound used to measure velocity of blood flow in Uterine Arteries . Various measurement indices like UAPI(Uterine Artery Pulsatality Index),UARI(Uterine Artery Resistance Index) & techniques have been used to evaluate relation between Uterine Arterine Doppler velocimetry & Adverse pregnancy outcomes . UAPI is impedence of flow of blood in uterine Arteries and hence it helps to measure resistance to blood flow in Uteroplacental bed . It is measured as (PSV-EDV) / TAV where as UARI=(PSV-EDV) / PSV. Plasencia et. al. in a prospective study found that Mean Uterine Arterine PI has a normal Reference range in 1 st trimester as 1.82 ± 0.70 . Mean UAPI>95th percentile along with notching in a waveform is associated with adverse pregnancy outcomes .Mean UAPS >2.35 signifies Pre Eclampsia & IUGR. As the gestational increases UAPI and UARI decreases due to remodelling of spiral arteries , failure of remodelling leads to increase in UAPI and UARI.

4. To measure UAPI , by transabdominal ultrasound technique, first midsaggital section of uterus & cervical canal is obtained & transducer is used to localise paracervical vessels. Colorflow Doppler is applied and flow velocity waveforms from ascending uterine artery branch closest to internal os above 2mm away from it is obtained highest systolic end diastolic velocity with small angle of insonation (<30)is used when three consecutive similar waveform s are obtained . PI can be measured and mean PI is calculated as average from it after calculating PI of left and right uterine artery . In a non pregnant uterine artery Doppler waveform consist of two waves that consist of rapid rise and fall during systole and notch in early diastole due to high Resistance flow in spiral Arteries. During normal pregnancy due to cytrophoblastic invasion in 8-10 weeks and 16-18 weeks , resistance flow in spiral arteries decreases , that leads to changes in waveforms . EDF increases Diastolic Notch disappears . In condition like Pre- Eclampia , IUGR , failure of complete Remodelling occur. Hence , Diastole Notch persists .Identifying pregnancy in early gestation with high risk factors is a major challenge in fetal Medicine .Doppler velocity plays as an important screening tool to access placental circulation and helps in early prediction of various high risk factors in pregnancy , so hereby thus study is planned to find out fetomaternal outcome in population of Haryana so that required measures can be taken at earliest to prevent unforeseen events.

5. Research Question Whether first trimester Mean Uterine Artery Doppler changes affects obstetric outcomes?

6. Aim and objectives AIM of the study : To study the fetomaternal outcome in pregnancy associated with abnormal mean of first trimester Uterine Artery Doppler Objective of the study: To find out maternal outcome in pregnancy with abnormal first trimester Uterine Artery Doppler To study foetal outcomes in pregnancy with abnormal first trimester Uterine Artery Doppler. To compare fetomaternal outcome using abnormal Uterine Artery Doppler with uncomplicated pregnancy. To see the relation in different values of Mean of first trimester Uterine Artery Doppler. To explore potential of first Trimester Uterine Artery Doppler as screening tool for Diagnosing pregnancy outcomes.

7. Material and Method The present study will be conducted in the department of Obstetrics and Gynecology at Pt. B.D. Sharma PGIMS Rohtak on women attending antenatal OPD at 11 – 13 weeks + 6 days after taking informed and written consent. Type of study: Prospective observational study. Study period : One year

8. Inclusion and exclusion criteria Inclusion criteria Singelton pregnancy Between 11 – 13 weeks + 6 days of gestation. Pregnancy with high risk factors like age >35 year, BMI <18 or >30 , Family history of diabetes mellitus, Hypertension, SLE, Bad Obstetrics history like pre-eclampsia, Intrauterine growth restriction, pre-term labour pains. Exclusion criteria Multiple pregnancy Pre-existing Foetal anomalies incompatible with life Not consenting

9. Sample size: Sample size is calculated on basis of previous study ( Khong SL, Kane SC, Brennecke SP, da Silva Costa F.) N=2 (Z α + Z 1-β ) 2 * σ 2 / ▲ 2 Z α was 1.96 Z 1-β was 0.84 power was 80% percentages of effect (▲) was 47% (base on history of preeclampsia) standard deviation (σ) was 0.84. N = 2 * (1.96+0.84) 2 * (0.84) 2 / (0.47) 2 = 15.68 * 0.705 / 0.22 = 11.06 / 0.22 = 50.29 = 50 Hence the sample size can be taken as 50 in each group.

10. Though the sample size came out to be 50 but t otal sample size of 100 will be taken out of which 50 will be taken as cases for the study. Total 100 pregnant women will be taken and they will be divided in two groups, group A and group B, Group A includes 50 women with High risk factor like age >35 year, BMI <18 or >30, Family history of diabetes mellitus, Hypertension, SLE, Bad Obstetrics history like pre-eclampsia, Intrauterine growth restriction, pre-term labour pains and group B includes 50 women with uncomplicated pregnancy having singleton pregnancy with 11-13 weeks + 6days without any high risk factors that will be taken as control. Control group: For recruitment in control group every women coming next to the study case having almost similar gestation age within one week. During follow up if any time diagnosed with abnormal Uterine Artery Pulsatility Index they will be excluded from control group and taken into the study group. After taking written and informed consent and fulfilling the inclusion criteria, patients will be included in the study. Detailed history regarding the demographic profile, menstrual cycles, antenatal history, obstetric history will be taken. A thorough clinical examination in reference to general physical, systemic and per abdomen examination will be carried out as per proforma.

11. All preliminary investigations including, complete haemogram , Blood group and Rh typing, Glucose challenge test, TSH, HIV, STS, HBsAg, Urine routine and microscopy, USG and any additional investigation if indicated will be performed as per proforma. USG Doppler study will be conducted and th e values of Pulsatility Index, resistance index of Uterine Artery will be calculated and documented. Patient will followed till discharge as per hospital protocol. Details regarding Development of Pre- eclampsia, Intrauterine, Growth restriction, AFI, delivery interval, changes in Mean UAPI, Treatment protocol given, mode of delivery and postnatal complication will be noted down. The details of the baby like weight of baby, sex, maturity, APGAR score, meconium staining, admission of baby to neonatal intensive care unit (NICU) and neonatal complication will be recorded. From the detailed history, examination and investigation, if any etiological factors found will be noted down. Both the groups (control/study) will be compared in relation to fetomaternal outcome.

12. PATIENT PROFORMA Serial No. Registration No. Group:-case/control. Name Age Education Occupation Husband Name Address   Menstrual History: Last date of periods.................EDD..............POG.......   Obstetric History: Obstetric formula Duration of Marriage Spontaneous or assisted conception Any H/O complication in previous pregnancies in mother and fetus H/o DM, HTN, TB, Thyroid, Asthma, jaundice   Examination General physical examination Weight Height Pulse / BP Pallor/Icterus/ Cynosis /clubbing/JVP/Pedal edema Respiratory Examination: Cardiovascular Examination: Per abdominal Examination: Presentation Uterine height Clinical liquor Hb ABO Rh HCV GCT HIV HBsAg TSH Urine C/E

13.   At time of Admission Week 1 Week 2 Week 3 Week 4 Maturity           Estimated fetal Weight           UAPI           Additional investigation. Associated high risk condition Anemia:-moderate/severe Preeclampsia FGR Congenital malformation Treatment given: Mode of Delivery; Normal Vaginal/ Instrumental vaginal delivery ( vaccum / forceps delivery)/ Caesarean Section with indication. Complication of labor Post natal complications:-PPH/sepsis/mortality. FETAL OUTCOME Birth weight Sex of baby One and Five minute APGAR score Meconium staining of liquor Admission in NICU Neonatal complication:- Neonatal hypoglycaemia /Neonatal seizure/Respiratory problems Ultrasonography for cases .