Fetal biophysical profile and doppler velocimetry of fetal and feto-placental circulation in pregnants with hypertensive disease: a comparative study of perinatal outcomes

Abstract

Introduction: Hypertension disease, including a Specific Hypertensive Disease of Pregnancy (SHDP), Systemic Arterial Hypertension (SAH), Chronic Systemic Arterial Hypertension (CSAH) and CSAH with SHDP, could result in placental insufficiency which is strongly related to Intrauterine Growth Restriction (IUGR), a disease associated to a high risk of perinatal morbi-mortality. Is extremely important to evaluate intrauterine conditions, so it can be decided the treatment, following and even the interruption of these pregnancies; at this moment, Cardiotocgraphy (CTG), Fetal Biophysical Profile (FBP) and Doppler velocimetry become important for pre-natal following. Objective: To evaluate the role of CTG, FBP and Doppler velocimetry on the hypertension disease, comparing SHDP and non-SHDP groups and analyzing their values against postnatal outcomes. Materials and methods: It’s a retrospective study in which we analyze the file of 247 pregnant women that had their labors at HCFMUSP, between November of 2005 and November of 2006. The following diagnosis methods have been analyzed: CTG, FBP, Doppler velocimetry of umbilical artery (A/B and PI) and of medial brain artery and ultrassonography. The studied perinatal outcomes were: Apgar score, umbilical artery gasometry and newborn weight classification, according to gestational age. The statistical studies were Fisher test and qui-quadrado (2), which were considered significant when p<0,05. Results: Patients with SHDP diagnosis had abnormal results of Doppler velocimetry of umbilical arteries in A/B (p=0,0424) and PI (p=0,0286 13), a higher proportion of IUGR in USG (p=0,0294) and abnormal 24 hours proteinuria (p<0,0001). This method also showed correlation with Small for Gestational Age (SGA) babies (p 0,0032), Apgar (p 001806) and pH (p 0,0086). CTG also showed a higher correlation with SGA babies (p 0,0017). Conclusion: Only Doppler velocimetry of umbilical arteries were correlated with SHDP, as well as Apgar and pH<7,20. Besides, Doppler and CTG correlated with the occurrence of SGA babies. So Doppler were clearly superior inpredicting the adverse perinatal outcomes.