RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and address ( in block letters) / : / DR.REVANESH.N
DEPARTMENT OF RADIODIAGNOSIS
MAHADEVAPPA RAMPURE MEDICAL COLLEGE, GULBARGA – 585105
Permanent address / : / S/O SIDRAM.N
“PAVITRA NIVAS”,PLOT NO: 36,
VIVEKANAND NAGAR,
OPP. DHANWANTRI HOSPITAL
JEWARGI ROAD, GULBARGA -585102
2 / Name of the institution / : / H.K.E. SOCIETY’S MAHADEVAPPA
RAMPURE MEDICAL COLLEGE,
GULBARGA – 585105
3 / Course of study and subjects / : / M.D.(RADIODIAGNOSIS)
4 / Date of admission to the course / : / 30TH MAY 2009
5 / Title of Topic / : / ROLE OF DOPPLER ULTRASOUND IN PREGNANCY INDUCED HYPERTENSION
6 / Brief Resume of the intended work
6.1 / Need for the study
Hypertensive disorders of pregnancy is one of the most common complication that affects pregnancy, and one of the leading cause of maternal, fetal morbidity and mortality. Pregnancy induced hypertension is seen in about 15% of pregnancies and is responsible for 18% of fetal and infant mortality, and 46% of infants born are Small for gestational age.
Compromised uteroplacental perfusion from vasospasm in pregnancy induced hypertension is a major cause for increased perinatal mortality and morbidity like IUGR.
Doppler ultrasound is a simple, non-invasive, widely available, cost-effective and reproducible technique for the study of uteroplacental and fetal circulation.
Early recognition of fetal compromise by Doppler Ultrasound may help in reducing the incidence of perinatal mortality and morbidity.
6.2 / Review of Literature
Color Doppler is an excellent tool for non-invasive hemodynamic monitoring of PIH patients. It helps to identify the fetuses at risk and predict perinatal morbidity and mortality. Doppler velocimetry can guide us in the management of these pregnancies and prevention of high mortality and morbidity in these patients1.
Chien PF, Arnott N, Gordon A, Owen P, Khan KS concluded in their study that Doppler showed 95% accuracy in predicting preeclampsia, intrauterine growth retardation and perinatal death2.
Yoon BH, Lee CM, Kim SW performed Umbilical artery velocimetry studies within 7 days of delivery in 72 consecutive patients admitted with preeclampsia. They concluded that an abnormal Doppler umbilical artery waveform is a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia3.
Pathological Doppler velocimetry of the uterine and uteroplacental circulation was a powerful predictor of PIH and/or IUGR in high-risk pregnancies, identifying a group in which 58.3% would suffer from disease later in pregnancy. A combination of several Doppler parameters was superior to a single parameter, although the parameters strongly correlated with each other4.
S/D ratio of MCA/UA is the most sensitive and specific index in predicting major perinatal adverse outcome (83% and 75%), while umbilical artery S/D ratio is the most sensitive index (66.6%) in predicting any adverse perinatal outcome i.e. including both major (like perinatal deaths) and minor outcome (like fetal distress). MCA pulsatility index (P.I) is the most specific index (90.9%) for predicting any adverse perinatal outcome. The sensitivity of the Doppler studies can be significantly increased by studying multiple vessels (91.6%). Doppler studies of multiple vessels in the fetoplacental circulation helps in the monitoring of compromised fetus and can help in predicting neonatal morbidity. This is helpful in determining the optimal time of delivery in complicated pregnancies5.
A reduction in fetal growth velocity preceded changes observed in the fetal circulation. Ratios of the fetal Doppler parameters provided the clearest evidence of deterioration in the fetal condition. The information provided may be of use in the diagnosis and management of the growth-restricted fetus6.
In suspected IUGR, while an abnormal Umbilical Artery PI is a better predictor of adverse perinatal outcome than an abnormal Middle Cerebral Artery or Renal Artery PI, a normal Middle Cerebral Artery PI may help to identify fetuses without major adverse perinatal outcome, especially before 32 weeks gestational age7.
6.3 / Objectives of the study
1.  To analyse the blood flow in umbilical artery, middle cerebral artery and uterine artery using Doppler Ultrasound in a group of patients with pregnancy induced hypertension.
2.  To assess the value of Doppler ultrasound in predicting the perinatal outcome in patients with pregnancy induced hypertension.
3.  To evaluate the role of Doppler Ultrasound in the management of pregnancy induced hypertension.
7 / Materials and methods
7.1 / Source of data
All Patients with clinically diagnosed pregnancy induced hypertension referred to
1.  Basaveshwar Teaching and General Hospital, Gulbarga and
2. Sangameshwar Teaching and General Hospital, Gulbarga.
7.2 / Methods of collection of data ( including sampling procedure, if any)
The study will be conducted on a minimum of 50 patients with clinically diagnosed pregnancy induced hypertension who are referred to Department of Radiodiagnosis, Basaveshwar Teaching and General Hospital, Gulbarga and Sangameshwar Teaching and General Hospital, Gulbarga during the period of December 2009 to September 2011. But the scope for increasing the number of cases exists depending on the availability of patients within the study period.
All patients will undergo Doppler ultrasound study and will be followed up till delivery and for perinatal outcome.
Consent will be taken from the patient or the guardian.
Inclusion criteria :
1.  All antenatal cases more than 26 weeks of gestation clinically
diagnosed as pregnancy induced hypertension.
Exclusion criteria :
1. All antenatal cases with chronic hypertension
2. All antenatal cases less than 26 weeks of gestation clinically diagnosed as pregnancy induced hypertension.
3. All antenatal cases with abnormal Doppler findings without pregnancy induced hypertension.
4. Intrauterine death at the time of first Doppler examination.
5. Patients who cannot be followed up.
7.3 / Does the study require any investigation or intervention to be conducted on patients or other humans or animals? if so please describe briefly
YES , It requires Doppler study as a mode of evaluation. No interventional procedure is needed for this study.
7.4 / Has ethical clearance been obtained from your institution in case of 7.3 ?
Yes. Ethical clearance has been obtained from “Ethical Clearance Committee” of the institution,
8 / List of References
1.  Bhatt CJ, Arora J, Shah MS. Role of color doppler in pregnancy induced hypertension (a study of 100 cases). Indian J Radiol Imaging 2003; 13: 417-20.
2.  Chien PF, Arnott N, Gordon A, Owen P, Khan KS. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia,intrauterine growth retardation and perinatal death? A overview. Br J Obstet Gynaecol. 2000 Feb; 107(2): 196-208.
3.  Yoon BH, Lee CM, Kim SW. An abnormal umbilical artery waveform: a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obstet Gynecol. 1994; 171: 713-21.
4.  Zimmermann P, Eirio V, Koskinen J, Kujansuu E, Ranta T. Doppler assessment of the uterine and uteroplacental circulation in the second trimester in pregnancies at high risk for pre-eclampsia and/or intrauterine growth retardation: comparison and correlation between different Doppler parameters. Ultrasound Obstet Gynecol. 1997; 9: 330-338.
5.  Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler Prediction of Adverse Perinatal Outcome in PIH and IUGR. Ind J Radiol Imag. 2006; 16(1): 109-116.
6.  Harrington K, Thompson MO, Carpenter RG, Nguyen M, Campbell TS. Doppler fetal circulation in pregnancies complicated by pre-eclampsia or delivery of a small for gestational age baby: Longitudinal analysis. British Journal of Obstetrics and Gynaecology. May 1999; 106: 453-466.
7.  Katherine W Fong, Arne Ohlsson, Mary E Hannah, Sorina Grisaru, John Kingdom, Howard Cohen. Prediction of Perinatal Outcome in Fetuses Suspected to Have Intrauterine Growth Restriction: Doppler US Study of Fetal Cerebral, Renal, and Umbilical Arteries. Radiology 1999; 213: 681-689.
9 / Signature of Candidate
10 / Remarks of guide / The study has immense value in the management of patients with pregnancy induced hypertension and has been suggested by me as the topic for dissertation.
11 / 11.1 / Name and designation of the Guide / DR.CHETAN.S.DURGI
M.D., D.M.R.D.
ASSOCIATE PROFESSOR,
DEPARTMENT OF RADIODIAGNOSIS,
M.R. MEDICAL COLLEGE, GULBARGA
11.2 / Signature
11.3 / Co- guide (if any)
11.4 / Signature
11.5 / Head of the Department / Dr.SURESH B.MASIMADE
M.D., R.D.
I/C PROFESSOR & HEAD OF THE DEPT.
DEPARTMENT OF RADIODIAGNOSIS
M.R.MEDICAL COLLEGE, GULBARGA
11.6 / Signature
12 / 12.1 / Remarks of the Chairman and Principal
12.2 / Signature