Role of Doppler Ultrasonography in Predicting Adverse Outcomes in High-Risk Pregnancies

Abstract

Background: High-risk pregnancies are associated with increased maternal and perinatal morbidity and mortality, particularly because of placental insufficiency, fetal growth restriction (FGR), hypertensive disorders, oligohydramnios, and other maternal or fetal complications. Doppler ultrasonography provides a non-invasive assessment of fetoplacental and uteroplacental circulation and can identify hemodynamic changes before overt fetal compromise becomes clinically evident. Abnormal umbilical artery (UA), middle cerebral artery (MCA), uterine artery (UtA), and cerebroplacental ratio (CPR) parameters have been associated with adverse perinatal outcomes.

Aim: To evaluate the role of obstetric Doppler ultrasonography in predicting adverse maternal and perinatal outcomes among women with high-risk pregnancies.

Methods: A prospective observational study was conducted in the Department of Radiodiagnosis, Government General Hospital, Siddhartha Medical College, Vijayawada, over a period of one year. A total of 120 women with singleton high-risk pregnancies were enrolled. Detailed clinical and obstetric assessment was performed, followed by ultrasonographic evaluation of fetal growth, amniotic fluid, umbilical artery, middle cerebral artery, uterine artery, and cerebroplacental ratio. Participants were followed until delivery, and maternal and neonatal outcomes were documented. Abnormal Doppler findings were correlated with adverse outcomes. Statistical analysis was performed using SPSS version 26.0. Categorical variables were analysed using the chi-square/Fisher’s exact test, while diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). A p-value <0.05 was considered statistically significant.

Results: Of the 120 high-risk pregnancies, 38 (31.7%) had abnormal Doppler findings and 82 (68.3%) had normal Doppler findings. Adverse perinatal outcomes occurred in 29 (24.2%) pregnancies. Adverse outcomes were significantly more frequent among women with abnormal Doppler findings than among those with normal Doppler findings (57.9% vs. 8.5%, p<0.001). Fetal growth restriction, preterm delivery, low birth weight, NICU admission, and low 5-minute Apgar score were significantly more frequent in the abnormal-Doppler group. Abnormal UA Doppler showed the strongest association with adverse outcomes, while a reduced CPR also demonstrated significant predictive value. In the illustrative analysis, abnormal UA Doppler demonstrated a sensitivity of approximately 79%, specificity of 88%, PPV of 61%, and NPV of 95% for adverse perinatal outcome.

Conclusion: Doppler ultrasonography is a valuable non-invasive surveillance tool in high-risk pregnancies. Abnormal fetoplacental and cerebral Doppler parameters, particularly UA Doppler and CPR, are associated with an increased risk of adverse perinatal outcomes. Incorporation of Doppler assessment into the surveillance of appropriately selected high-risk pregnancies may facilitate earlier recognition of placental insufficiency and timely obstetric intervention.