Special Issue Article - Gynecology and Reproductive Endocrinology (2021) Volume 5, Issue 4
Dual markers and Uterine Artery doppler for early prediction of HDP and FGR- the way forward
Statement of Problem: The incidence of Hypertensive disorders in pregnancy is about 10% in antenatal women around the world, while that of FGR is between 3 to 7%. These conditions are associated with a high rate of perinatal morbidity and mortality, posing a need for their prediction early during pregnancy. Methodology and theoretical orientation: Pathophysiology of HDP and FGR has its bearing early during pregnancy. Thus, conducting screening tests at 11-13 weeks can help identify a high-risk group. In our study, Ut Artery Doppler was linked to the booking tests (Nuchal scan and Dual markers). Patients with first antenatal visit before 10 weeks gestation underwent routine NT scan between 11–13 weeks with bilateral Uterine Artery doppler-Resistivity Index assessment of the maternal uterine arteries. The placental volume was assessed. Serum dual biomarker test (β hCG and PAPP-A) was performed after this scan and analysed as multiples of median (MoM). Patients were followed up during the antenatal period as per the routine protocol. Blood pressure was recorded at every ANC visit till 2 weeks after delivery. Neonatal anthropometry was recorded at birth.
Findings: Our study revealed, the mean values of PAPP-A levels in normotensive group as 1.32±0.91 MoM while that of PIH groups were 0.68±0.39 MoM, showing statistically significant difference. The serum PAPP-A levels showed statistically significant difference between Non-IUGR and IUGR groups (1.24±0.87 MoM and 0.46±0.20 MoM respectively).
Conclusion and significance: Our study observes PAPP-A level as a good indicator for possible prediction of HDP and FGR. Similar studies carried out by other authors across the globe have suggested the utility of many blood parameters along with doppler techniques to optimise the management plan by early prediction of HDP and FGR. These studies help in initiating therapies as early as 12–14 weeks into the pregnancy to prevent potential complications.Author(s): Dr Alka C. Bapat