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The objective of this controlled clinical trial was to
predict fetal lung maturity in diabetic pregnant women
undergoing elective uncomplicated cesarean section by
using pulmonary artery Doppler. Recent studies have been
demonstrated that Acceleration /Ejection time ratio in fetal
main pulmonary artery can predict fetal lung maturity as
measured by biochemical tests of amniocenteses or by
comparing with clinical outcome of delivered fetuses. The
study was conducted at Faculty of Medicine, Ain Shams
University Maternity Hospital during the period from
September 2017 to March 2018.
This study consisted of 80 patients prepared to do
fetal pulmonary artery Doppler ultrasound and designed as
the following 2 groups:
(Case group): consisted of 40 pregnant women with
controlled diabetes mellitus.
(Control group): consisted of 40 pregnant women not
complicated with diabetes mellitus.
All patients from both groups underwent informed
written consent followed by full history, general xamination, abdominal examination ,blood sugar tests and
real time two dimensional abdominal U/S.
Women were placed in semi recumbent position and
an axial plane through the fetal thorax to achieve 4 chamber
view of the heart. The main pulmonary artery was followed
to the point where it divides into right and left branches by
rotating the transducer from the 4 chamber view to the
short axis view of the heart. Pulsed and color Doppler was
used. The fetal pulmonary artery flow waveform (FPAF)
measurements have been taken within the proximal portion
of the main pulmonary artery.
A number of different parameters were measured from
the FPAF waveform (average values of 3 waves), including
the systolic/diastolic ratio, pulsatility index (PI), resistance
index (RI), and the acceleration time/ejection time ratio
(At/Et). All measurements was performed by senior single
sonographer with same U/S machine
After delivery, neonatal resuscitation and assessment
was done by senior neonatologist.
The results of the present study demonstrated that
there were statistical significant differences between infants
born with RDS and infants without RDS in women with
controlled DM as regard PA At/Et ratio but here is no statistical significant differences as regard other PA
The Mean PA At/Et ratio was significantly higher in
infants born with RDS than infants born without RDS in
women with controlled DM (0.34 vs 0.21 respectively), (p
< 0.05 = <0.0001) and Receiver-operating characteristic
(ROC) curve for prediction of RDS in patients with
controlled DM using PA At/Et ratio had excellent
predictive value (AUC = 0.740, p-value 0.012). A cutoff
criterion of PA At/Et ratio >0.25 had a sensitivity of 75%
and specificity of 88.9%.