Doppler Study of Foetal Middle Cerebral Artery and Umbilical Artery in Prediction of Neonatal outcome in Preeclampsia

Introduction Preeclampsia is the first cause of maternal morbidity and mortality, intrauterine growth retardation (IUGR), and fetal prematurity (Abdel Razik, 2016). Preeclampsia affects 5-10% of pregnancies and is clinically manifested after 20 weeks of gestation. Fetal hypoxemia caused by preeclampsia can lead to ischemic encephalopathy, growth retardation, and various sequalae of premature birth. Abnormal trophoblastic invasion of uterine vessels is a major cause of hypertension associated with preeclampsia syndrome. In fact, studies have shown that the degree of incomplete trophoblastic invasion of the spiral arteries is directly correlated with the severity of subsequent maternal hypertension. This is because the placental hypo perfusion resulting from the incomplete invasion leads by an unclear pathway to the release of systemic vasoactive compounds that cause an exaggerated inflammatory response, vasoconstriction, endothelial damage, capillary leak, hypercoagulability, and platelet dysfunction, all of which contribute to various clinical features of the disease and affect fetal oxygenation that leads to fetal hypoxemia (Abuhamad ,2008) This hypoxemia is associated with increased impedance to flow in the umbilical artery and decreased impedance in the fetal middle cerebral artery (Berks D 2015). Consequently, Doppler measurement of umbilical and middle cerebral artery pulsatility index may plays a role in the assessment and monitoring for fetal oxygenation in pregnancy associated with preeclampsia (Duley,2010). Obstetrical decision might improve and prevent intrauterine death because hypoxic cerebral damage may begin before labor and intrapartum asphyxia is probably more damaging when superimposed on underlying hypoxia Doppler assessment may lead to intervention that reduces the risk of fetal brain damage (Harmon,2015).