Sonographic Predictors of Adverse Perinatal Outcomes in Pregnancies Complicated by Hyperglycaemia

Ultrasound has an important role in in pregnancy complicated by hyperglycaemia. This study is to assess the association between third trimester ultrasound parameters and adverse outcomes in hyperglycaemic pregnant women & neonates.

A prospective observational study including 166 hyperglycemic pregnant women (39-preexisting; 127-GDM) Ultrasound was done between 34 weeks gestation and beyond to note parameters i.e. FW centile, AC centile, CPR ratio, AFI. All were followed till delivery; adverse outcomes noted (C-section done for fetal distress, arterial cord blood ph < 7.1, 5 min APGAR < 7, admission to neonatal unit, neonatal hypoglycemia, perinatal death). Composite adverse outcomes were determined by having any 2/7 above-described outcomes. Ultrasound parameters were then correlated with composite adverse outcomes and correlation was determined.

Out of 166; in 66 pregnancies composite adverse neonatal outcomes were present. Women with HIP having > 90th centile of estimated fetal weight have 3.52 times higher chances [OR 3.52 & 95% CI (1.55-7.97)] of having CAO compared to rest of the women. Statistically, a significant association was found for Composite Adverse Outcomes and deranged AFI (p value < 0.018). Women with HIP having Polyhydramnios have 3.13 times higher odds [OR 3.13 & 95% CI (1.08-8.94)] of having CAO compared to rest of the women. Further, Women with HIP having cerebroplacental insufficiency i.e. CPR < 1 have 4.2 times higher odds [OR 4.200 (CI 1.825-9.668)] of having CAO compared to rest of the women with HIP i.e. women having CPR > 1.

In women with hyperglycemia, third trimester USG parameters have an important role in predicting adverse outcomes beyond the impact of maternal predictors. The best combination of USG parameters detecting Composite Adverse Outcomes was EFW < 10th centile and CPR < 1 (OR 14.61). So third trimester sonographic parameters appears to be promising tool to preplan deliveries that should be conducted in tertiary care centres to reduce perinatal morbidity and mortality.