The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa
Background: The assessment of fetal blood flow using Doppler waveform can be used to identify placental insufficiency, and hence is a tool to identify fetuses at risk of stillbirth due to fetal growth restriction (FGR). In South Africa the largest category of perinatal deaths is ‘unexplained intraut...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021000729 |
| _version_ | 1818920053294235648 |
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| author | TMAG Hlongwane T Cronje BSS Nkosi RC Pattinson |
| author_facet | TMAG Hlongwane T Cronje BSS Nkosi RC Pattinson |
| author_sort | TMAG Hlongwane |
| collection | DOAJ |
| description | Background: The assessment of fetal blood flow using Doppler waveform can be used to identify placental insufficiency, and hence is a tool to identify fetuses at risk of stillbirth due to fetal growth restriction (FGR). In South Africa the largest category of perinatal deaths is ‘unexplained intrauterine death’. The majority of the mothers are clinically healthy women. This study was performed to determine the prevalence of abnormal umbilical resistance indices (abnormal RI) to see if screening a low-risk pregnant population is worthwhile. Methods: A descriptive study across 9 sites in 8 provinces of South Africa was performed to determine the prevalence of abnormal RI of the umbilical artery in women classified as having a low-risk pregnancy. The study was conducted from 1st September 2017- February 2020.The pregnant women classified were screened using a continuous wave Doppler ultrasound apparatus (Umbiflow™) between 28 and 34 weeks’ gestation. Women with fetuses with an abnormal RI were referred to a high-risk clinic and were managed according to standard protocol. The outcomes of all the deliveries were recorded. Findings: Umbiflow™ screening of the umbilical artery was performed in 7088 women across nine sites; 919 (13·0%) fetuses had an abnormal RI. Absent end diastolic flow (AEDF) was found in 87 (1·2%) fetuses. The prevalence of small for gestational ages (SGA) babies was 23·1% in the normal RI group and was significantly higher in the abnormal RI group 32·1% (p<0·0001). There was a statistical difference in the perinatal mortality rate between the normal RI (9.8/1000) and abnormal RI group (21.4/1000) [RR 0·046; 95% CI -0·06–0·98]. Interpretation: The prevalence of abnormal RI and AEDF in this screened low-risk population was about ten times higher than that previously recorded in high income countries. Continuous wave Doppler ultrasound screening detected previously undiagnosed growth restricted babies. The prevalence of AEDF warrants continuous wave Doppler ultrasound screening of the low-risk pregnant population in South Africa. Funding: This study was funded by the South African Medical Research Council (SAMRC) and the Council for Scientific and Industrial Research (CSIR) |
| first_indexed | 2024-12-20T01:15:38Z |
| format | Article |
| id | doaj.art-5cc3ef8f7b2c4432af3b577d541ebd78 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-20T01:15:38Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-5cc3ef8f7b2c4432af3b577d541ebd782022-12-21T19:58:34ZengElsevierEClinicalMedicine2589-53702021-04-0134100792The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South AfricaTMAG Hlongwane0T Cronje1BSS Nkosi2RC Pattinson3Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Corresponding author at: South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa.Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, South AfricaDepartment of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South AfricaDepartment of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South AfricaBackground: The assessment of fetal blood flow using Doppler waveform can be used to identify placental insufficiency, and hence is a tool to identify fetuses at risk of stillbirth due to fetal growth restriction (FGR). In South Africa the largest category of perinatal deaths is ‘unexplained intrauterine death’. The majority of the mothers are clinically healthy women. This study was performed to determine the prevalence of abnormal umbilical resistance indices (abnormal RI) to see if screening a low-risk pregnant population is worthwhile. Methods: A descriptive study across 9 sites in 8 provinces of South Africa was performed to determine the prevalence of abnormal RI of the umbilical artery in women classified as having a low-risk pregnancy. The study was conducted from 1st September 2017- February 2020.The pregnant women classified were screened using a continuous wave Doppler ultrasound apparatus (Umbiflow™) between 28 and 34 weeks’ gestation. Women with fetuses with an abnormal RI were referred to a high-risk clinic and were managed according to standard protocol. The outcomes of all the deliveries were recorded. Findings: Umbiflow™ screening of the umbilical artery was performed in 7088 women across nine sites; 919 (13·0%) fetuses had an abnormal RI. Absent end diastolic flow (AEDF) was found in 87 (1·2%) fetuses. The prevalence of small for gestational ages (SGA) babies was 23·1% in the normal RI group and was significantly higher in the abnormal RI group 32·1% (p<0·0001). There was a statistical difference in the perinatal mortality rate between the normal RI (9.8/1000) and abnormal RI group (21.4/1000) [RR 0·046; 95% CI -0·06–0·98]. Interpretation: The prevalence of abnormal RI and AEDF in this screened low-risk population was about ten times higher than that previously recorded in high income countries. Continuous wave Doppler ultrasound screening detected previously undiagnosed growth restricted babies. The prevalence of AEDF warrants continuous wave Doppler ultrasound screening of the low-risk pregnant population in South Africa. Funding: This study was funded by the South African Medical Research Council (SAMRC) and the Council for Scientific and Industrial Research (CSIR)http://www.sciencedirect.com/science/article/pii/S2589537021000729Antenatal careDoppler ultrasoundIntrauterine growth restrictionSmall for gestational ageStillbirthNeonatal death |
| spellingShingle | TMAG Hlongwane T Cronje BSS Nkosi RC Pattinson The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa EClinicalMedicine Antenatal care Doppler ultrasound Intrauterine growth restriction Small for gestational age Stillbirth Neonatal death |
| title | The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa |
| title_full | The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa |
| title_fullStr | The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa |
| title_full_unstemmed | The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa |
| title_short | The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa |
| title_sort | prevalence of abnormal doppler s of the umbilical artery in a low risk pregnant population in south africa |
| topic | Antenatal care Doppler ultrasound Intrauterine growth restriction Small for gestational age Stillbirth Neonatal death |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021000729 |
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