Role of Color Doppler Flowmetry in Prediction of Intrauterine Growth Retardation in High-Risk Pregnancy

Doppler in High-Risk Pregnancy and Its Correlation With Feto-Maternal Outcomes: A Prospective Study

INTRODUCTION

In the current times, fetal growth monitoring has become readily available with the help of Doppler ultrasound. Identification of pregnancies that are at risk for perinatal morbidity and mortality has been a primary goal of obstetric care. Doppler study is a fast, non-invasive test that provides significant information about the hemodynamic status of the fetus. It is an efficient diagnostic modality to assess fetal compromise, which helps in timely intervention in high-risk pregnancies for better perinatal outcomes.

OBJECTIVES

The objectives of this study were to know the correlation between antenatal Doppler findings and perinatal outcomes, including preterm labor, cesarean section, birth weight, and rate of admission of neonates in the neonatal intensive care unit (NICU). Admission to NICU was taken as the primary outcome.

METHODS

This is a tertiary care hospital-based prospective study done at Maharaja Agrasen Medical College, Agroha, India. A hundred high-risk pregnant women with oligohydramnios, intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), diabetes mellitus (DM), anemia, or Rh incompatibility were included. Pregnancies in the first and second trimesters and congenital anomalies in babies were excluded from the study. The patients were examined for a Doppler study of the umbilical artery, fetal middle cerebral artery (MCA), and both maternal uterine arteries. Parameters in the form of a resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) of all the arteries were taken. Details of delivery and fetal outcomes were recorded. Data were correlated with Doppler findings. For comparing categorical data, the chi-square (X2) test and Fisher's exact test were performed. The comparison of continuous data between the two groups was done using an independent t-test. All statistical calculations were done using the computer program IBM SPSS Statistics for Windows, version 25 (released 2015; IBM Corp., Armonk, New York, United States).

RESULTS

All the 100 cases with either normal or abnormal Doppler were comparable in terms of maternal age and parity. The prevalence of oligohydramnios was 27% (N = 27), PIH was seen in 20% (N = 20), anemia in 19% (N = 19), IUGR in 12% (N = 12), and oligohydramnios with IUGR in 13% (N = 13). In oligohydramnios, maternal anemia, Rh incompatibility, and DM, Doppler was found to be normal. In PIH, IUGR, and oligohydramnios with IUGR, abnormal Doppler was seen in four (20%), two (16%), and 10 (76%) cases, respectively. Among 84 candidates with normal Doppler, 49 (58%) got delivered by the vaginal route. Out of 16 abnormal Doppler cases, five were vaginally delivered (31%). Among 16 patients with abnormal Doppler, 15 patients, i.e., 93.75%, had low birth weight (LBW, <2.5 kg) (p-value < 0.001), 93.75% (N = 15) delivered before 37 weeks, and 13 (81.25%) newborns were admitted in the nursery.

CONCLUSION

Abnormal Doppler was associated with an increased rate of low birth weight and admissions to the NICU with no effect on preterm delivery or cesarean section rates. The study strengthens the fact that Doppler studies in mothers can be used to plan the mode of delivery, predict the need for resuscitation, and anticipate the outcome of newborns.

Deconvolution of a Large Cohort of Placental Microarray Data Reveals Clinically Distinct Subtypes of Preeclampsia

It has been well established that the dysfunctional placenta plays an important role in the pathogenesis of preeclampsia (PE), a hypertensive disorder in pregnancy. However, it is not well understood how individual cell types in the placenta are involved in placenta dysfunction because of limited single-cell studies of placenta with PE. Given that a high-resolution single-cell atlas in the placenta is now available, deconvolution of publicly available bulk PE transcriptome data may provide us with the opportunity to investigate the contribution of individual placental cell types to PE. Recent benchmark studies on deconvolution have provided suggestions on the strategy of marker gene selection and the choice of methodologies. In this study, we experimented with these suggestions by using real bulk data with known cell-type proportions and established a deconvolution pipeline using CIBERSORT. Applying the deconvolution pipeline to a large cohort of PE placental microarray data, we found that the proportions of trophoblast cells in the placenta were significantly different between PE and normal controls. We then predicted cell-type-level expression profiles for each sample using CIBERSORTx and found that the activities of several canonical PE-related pathways were significantly altered in specific subtypes of trophoblasts in PE. Finally, we constructed an integrated expression profile for each PE sample by combining the predicted cell-type-level expression profiles of several clinically relevant placental cell types and identified four clusters likely representing four PE subtypes with clinically distinct features. As such, our study showed that deconvolution of a large cohort of placental microarray provided new insights about the molecular mechanism of PE that would not be obtained by analyzing bulk expression profiles.