Correlating the Blood Flow Class of Abnormal Umbilical Artery Doppler to Maternal Serum S100 b Protein and Endotheline-1 in Intrauterine Growth Retarded Fetuses
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- Category: Vol. 78, December 2010
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Correlating the Blood Flow Class of Abnormal Umbilical Artery Doppler to Maternal Serum S100 b Protein and Endotheline-1 in Intrauterine Growth Retarded Fetuses,DOAA SALAH EL-DIN, HALA A.E. WAHAB, EMAN ZEIN, ABD EL-GHANY MOHAMED and MARWA M. SHETA
Abstract
Background: Intra Uterine Growth Retardation (IUGR) is defined as birth weight below the 10th percentile for gesta-tional age. Doppler ultrasonography is one of the principal surveillance tools in pregnancies complicated by IUGR. Abnormal Doppler findings are usually investigated as a group without taking into consideration the degree of abnormality, thus using a scoring system for the umbilical artery wave forms can differentiate the degree of severity. The aim of the study is to correlate the umbilical artery Doppler blood flow class to maternal serum endotheline-1 and S 100 b protein in pregnancies complicated with IUGR.
Materials and Methods: 75 Patients pregnant between 30-37 weeks were divided into 2 groups: Study group which included 30 patients with pregnancy complicated by IUGR, and the control group which included 45 women, with un-eventful pregnancies. Blood sample collection for measuring serum endotheline-1 and S100 b protein was done. Umbilical artery Doppler recordings were performed. PI was calculated and the blood flow waveform was classified as blood flow class (BFC) 0-3. BFC 0 stands for normal umbilical artery blood flow velocity waveforms. Abnormal umbilical artery Doppler included BFC 1-3, where BFC 3 is absent or reversed end diastolic blood flow (ARED).
Results: Ten patients were excluded from the study. Maternal plasma ET-1 and S 100 b protein concentrations were high in IUGR group compared to control group (p value <0.001). Of the IUGR group 21 patients showed abnormal Doppler findings. Patients with ARED (BFC 3) had mean maternal serum ET-1 level of 19±1.1pmol/L and mean S100 b protein of 0.657±0.114ug/L. Both values showed significant difference from control (p value: <0.001 and 0.009 respec-tively). While mean serum ET-1 level and S100 b protein in BFC 0, 1 and 2 showed no statistical difference between the 2 groups. Six cases in the IUGR group were admitted to neonatal intensive care unit, all had S100 b protein above 0.72ug/L. Four cases had BFC 3, 1 case BFC 1 and 1 case BFC 2. A positive correlation was found between endotheline-1 level and BFC 3, r=0.71, p value: 0.016. Also S100 b protein showed positive correlation to BFC 3, r=0.536, p value=0.068.
Conclusion: Umbilical artery Doppler BFC correlates well to ET-1 level and S 100 b protein and both are increased in IUGR foetuses. IUGR foetuses should not be studied as one group to avoid misleading results. Umbilical artery Doppler scoring system together with endothelin-1 level correlates to severity in IUGR while S 100 b protein has a good predictive value concerning NICU admission.