<b>Umbilical Artery Doppler Indices In Hypertensive Disorders Of Pregnancy And Its Impact On Fetal Outcomes</b>

Background: Hypertensive disorders of pregnancy are major contributors to placental insufficiency and adverse perinatal outcomes. Umbilical artery Doppler can be used to assess fetoplacental vascular resistance, and may be indicative of fetoplacental compromise. Objective: To evaluate umbilical artery Doppler indices in women with hypertensive disorders of pregnancy and determine their association with fetal and neonatal outcomes. Methods: This prospective observational analytical cohort study included 180 singleton pregnant women with hypertensive disorders of pregnancy at Combined Military Hospital, Gujranwala. Umbilical artery Doppler assessment was performed before delivery, and participants were categorized into normal Doppler and abnormal Doppler groups. Doppler parameters included pulsatility index, resistance index, systolic/diastolic ratio, and end-diastolic flow pattern. Outcomes included low birth weight, fetal growth restriction, preterm birth, low Apgar score at five minutes, NICU admission, stillbirth, and early neonatal death. Results: Of 180 participants, 116 (64.4%) had normal Doppler findings and 64 (35.6%) had abnormal Doppler findings. Abnormal Doppler was associated with higher risks of low birth weight (45.3% vs 18.1%; RR 2.50, 95% CI 1.56–4.01), fetal growth restriction (40.6% vs 13.8%; RR 2.95, 95% CI 1.71–5.07), preterm birth (48.4% vs 20.7%; RR 2.34, 95% CI 1.51–3.62), low Apgar score (28.1% vs 8.6%; RR 3.26, 95% CI 1.60–6.64), NICU admission (37.5% vs 15.5%; RR 2.42, 95% CI 1.42–4.10), and stillbirth (10.9% vs 2.6%; RR 4.23, 95% CI 1.13–15.79). Early neonatal death was higher in the abnormal Doppler group but was not statistically significant. Conclusion: Abnormal umbilical artery Doppler indices were associated with a higher burden of adverse fetal and neonatal outcomes in hypertensive pregnancies. Umbilical artery Doppler may support risk stratification, closer surveillance, and delivery planning in pregnancies complicated by hypertensive disorders