A Thesis Submitted for Speciality Degree In Radiology Comparison of fetal umbilical artery and MCA Doppler indices changes secondary to polyhydramnios in diabetic and non-diabetic mothers

Abstract

The evaluation of amniotic fluid is one of the main variables to check the health of the fetus in the second and third trimester of pregnancy. An increase in amniotic fluid can affect the health of the fetus. Dopplervelocytometry of the umbilical artery and MCA of the fetus can be a newer and more reliable method for a better and more accurate assessment of the health status of the fetus. The aim of this study is to compare the severity of blood flow disorder in the umbilical artery and MCA of the fetus in IP and DP. If the severity of this disorder is similar in two groups, maintenance treatments to reduce the amniotic fluid volume in both groups can be useful. Materials & Method:In this study, singleton pregnancies with a calendar age of 30-41 weeks along with idiopathic polyhydramnios (IP) and diabetic polyhydramnios (DP) were included in the study from June 2020 to June 2022, following the inclusion and exclusion criteria. First, the patients were divided into two groups, diabetic and non-diabetic, and then each group was divided into three subgroups with mild polyhydramnios (AFI=25-30 cm), moderate polyhydramnios (AFI=30-35 cm), and severe polyhydramnios (AFI>35 cm). In all cases ,AFI and after fetal Dopplervelocytometry, PI and S/DR of the umbilical artery and PI, PSV and S/DR of the MCA of each fetus were measured. Ultrasound and doppler were performed in al-Zahra ultrasound center with medison (v20) ultrasound machine. Information about each patient was recorded in a special data collection form. After the end of the study, the recorded values for each group, according to the gestational age, were compared with the standard table values for AFI, PI and S/DR of the umbilical artery and PI, PSV and S/DR of the MCA. SPSS version 25 statistical software was used for analysis. P.value ≤ 0.05 was considered statistically significant. Results:138 pregnant mothers with polyhydramnios were examined in the third trimester, 70 of them were in the IP group and 68 were in the DP group. (Two diabetic patients were excluded from the study due to non-compliance with the study criteria.) Compared to the standard values, 14 patients in the IP group (20%) and 10 patients in the DP group (14.7%) had abnormal fetal Doppler indices. In the idiopathic group, the Doppler indices of the umbilical artery only in the severe subgroup with the other two subgroups, and the middle brain Doppler indices (except for MCA PSV) in all the subgroups of polyhydramnios severity, have found two-by-two significant differences. And in the diabetic group, the Doppler indices of the umbilical artery did not find a significant difference in any of the severity subgroups; And middle cerebral Doppler indices (except MCA PSV) in moderate and severe subgroups of polyhydramnios have found significant differences with other subgroups. The disorder of fetal umbilical cord and midbrain Doppler indicators, except for UA S/DR, was not related to diabetic or idiopathic polyhydramnios, and there was no significant difference between the two groups for other indicators, and this disorder is only dependent on the severity of polyhydramnios.