SONOGRAPHIC MEASUREMENT OF THE FETAL ADRENAL GLAND AS A MARKER OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA.

Abstract

Background Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality worldwide. The situation is alarming in Lower- and Middle-Income Countries like Ghana. Data from the two leading tertiary referral centres in Ghana corroborate these statistics. Perinatal morbidity and mortality rates remain high despite several advances. This has been the situation in the two leading Tertiary Health facilities in Ghana. Tools are needed to better predict perinatal outcomes, improve clinical decision-making, and facilitate parental counselling. The fetal adrenal gland plays a crucial role in the survival of the fetus in utero, ex-utero and later in life especially under stressful conditions like preeclampsia. Few studies have investigated the role of the ultrasound measurement of the fetal adrenal gland among growth-restricted fetuses. This is a major fetal complication of preeclampsia and further studies are needed to better elucidate the role of gestational-age-specific fetal adrenal gland size as a marker of adverse perinatal outcomes. Objective The main objective of the study was to evaluate the ultrasound measurement of the fetal adrenal gland dimensions and their relationship with adverse perinatal outcomes in preeclampsia. Methods This was a cross-sectional study conducted in a tertiary referral facility in Ghana, which explored the sonographic measurement of the human fetal adrenal gland and its relationship with adverse perinatal outcomes. The study involved 120 pregnant women aged at least 18 years and above with Preeclampsia, carrying singleton non-anomalous fetuses, with Estimated Gestational Ages above 28 weeks. Sonographic measurements of the Fetal Adrenal gland and key clinical data such as physical examination findings and important laboratory results were taken. Perinatal outcome data were extracted from patients’ records on the 7th day after delivery. Data captured was cleaned and transported into STATA 17.0 and analysed. The main outcome of the study was a composite of adverse perinatal outcome including low APGAR scores (<7) at the 5th minute, neonatal death, NICU admission, stillbirth, seizures, and iv Final version 1.0 6/2023 intubation, oxygen therapy. These were compared to the measured fetal adrenal gland dimensions. Results In all 80.00% were classified as having adverse perinatal outcomes and 20.00% had good perinatal outcomes. There was a statistically significant difference between the means of the fetuses that had an adverse perinatal outcome and a good perinatal outcome. The means of fetuses who eventually had an adverse outcome were smaller compared to those who had a good outcome. The Total Adrenal gland length and the Total Adrenal Gland Volume remained statistically significant even after adjusting for gestational age. P value <0.05 was used as the level of significance. The two dimensions obtained an Area Under the Receiver Operating Curve of 0.8268 and 0.8303. Conclusion There was a statistically significant relationship between the Total Adrenal Gland Length, Total Adrenal Gland Volume and perinatal outcomes of fetuses of mothers with preeclampsia with relatively good predictive ability. Further research is needed to calibrate its use.