The Effect of Third Trimester Corticosteroid Therapy on Fetal Doppler Velocimetry in Gestational Hypertension Complicated By Intrauterine Growth Restriction

Abstract

Background Althouh there is a great advance in antenatal care, gestational hypertension still one of the major reasons of maternal and neonatal morbidity and mortality. For this reason, early screening of gestational hypertension and fetal growth retardation can permit cautious antenatal monitoring and proper timing of delivery to steer clear of serious complications. Patient and Methods This is a prospective study that included 100 singleton pregnant women with gestational hypertension and complicated with IUGR fetuses who were divided into 2 groups (A and B), each group consists of 50 patients: All patients in group A subjected to fetal Doppler flow indices measurement before corticosteroid administration, and repeated within five days after its administration. Its effect on fetal outcome detected after termination of pregnancy. While women in group B included 50 patients who did not receive corticosteroid therapy. Fetal Doppler flow indices was measured, and after termination of pregnancy effect on fetal outcome was detected as well.  Results There was statistically significant difference between the study group after corticosteroid administration and the control group regarding the mean Doppler indices in the form of (MCA PI-RI, UMA PI-RI and CPR).  MCA shows higher values in study group after corticosteroid administration than the control group (PI 1.52 ± 0.10 and 1.5 ± 0.18 and RI from 0.78 ± 0.12 to 0.76 ± 0.02. While UMA shows lower values in study group after corticosteroid administration than the control group (PI 1.31 ± 0.16 and 1.36 ± 0.08 and RI 0.72 ± 0.01 and 0.73 ± 0.02. CPR also shows higher values in study group after corticosteroid administration than the control group 1.05 ± 0.05 and 1.04 ± 0.05. Conclusion Corticosteroid administration to hypertensive women is associated with improvement of all Doppler indices in the form of elevation of MCA PI & RI and CPR value and decrease of UMA PI & RI values. Although corticosteroid administration was associated with all these Doppler indices enhancement but there was no associated improvement in the number of fetuses born suffering from tachypnea or admitted to NICU when compared to the other group of women who did not receive corticosteroids. Fetuses who was delivered not affected by tachypnea or not admitted to the NICU shows improvement in UMA PI & RI and CPR in comparison to those who were tachypnic and admitted to the NICU. AEDFV and REDFV signs of UMA are critical signs, usually associated with adverse fetal outcome or fetal compromise.