الفهرس | Only 14 pages are availabe for public view |
Abstract 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 Doppler parameters. 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%. |