ROLE OF DUCTUS VENOSUS DOPPLER IN PREDICTION OF FETAL CARDIAC DYSFUNCTION IN PREECLAMPSIA

Abstract

Background: Venous Doppler changes generally accompany further metabolic deterioration of the
fetus and are a result of declining forward cardiac function and abnormal organ autoregulation.
Objectives: The aim of this study was to determine the correlation between ductus venosus (DV)
Doppler velocimetry and fetal cardiac troponin T (cTnT) as a biochemical marker of fetal cardiac
dysfunction in preeclamptic patient. Subjects and methods: A prospective study to 120 preeclamptic
women admitted to the Obstetrics and Gynecology department, Zagazig University Hospitals, from
May 2008 through November 2010. Patients recruited in this study were further divided according to
their Doppler study within 24 hours before delivery into 3 groups; group of normal arterial and venous
Doppler indices, group of abnormal arterial flow but normal ductus venosus flow and group of
abnormal arterial flow and abnormal ductus venosus flow. Immediately after delivery, umbilical artery
blood samples were obtained for the measurement of Ph and cTnT levels. Statistical analysis included
one way analysis of variance (ANOVA) test with LSD posthoc multiple 2-group comparisons.
Comparisons of quantitative variables within each group was done using Mann Whitney test for
independent samples. For comparing categorical data, Chi square (2) test was performed. Results: In
group of abnormal arterial flow and abnormal ductus venosus flow, Cord cardiac troponin T (cTnT)
concentrations at birth were >0.05 ng/ml in 22 (55%) cases, a proportion significantly higher than that
observed in groups of normal arterial and venous Doppler indices and of abnormal arterial flow but
normal ductus venosus flow (12.5% and 22.5% respectively; p < 0.01). Conclusion: Ductus venosus
pulsatility index of veins (DV PIV) was significantly related to high cord troponin (cTnT)
concentrations at delivery. Abnormal DV flow represents severe cardiac compromise, with increased
systemic venous pressure, and arise in right ventricular afterload, demonstrated by myocardial damage
and elevated fetal cTnT.
Keywords: Troponin T, ductus venosus, pulsatility index of veins