Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women
Article first published online: 23 DEC 2002
Ultrasound in Obstetrics & Gynecology
Volume 15, Issue 1, pages 7–12, January 2000
How to Cite
Coleman, M.A.G., McCowan, L.M.E. and North, R.A. (2000), Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women. Ultrasound Obstet Gynecol, 15: 7–12. doi: 10.1046/j.1469-0705.2000.00014.x
- Issue published online: 23 DEC 2002
- Article first published online: 23 DEC 2002
- Received 5–5–98, Revised 20–10–98, Accepted 8–2–99
- Uterine artery;
- Doppler ultrasound;
- High-risk pregnancy
Objective To assess the value of uterine artery Doppler ultrasound screening, when performed in a clinical setting, to predict complications of impaired uteroplacental blood flow in high-risk women.
Design A prospective audit.
Subjects A total of 116 pregnancies in 114 women at high risk of pre-eclampsia and/or small-for-gestational-age (SGA) babies attending a maternal–fetal medicine clinic at National Women’s Hospital, a tertiary referral hospital, Auckland, New Zealand.
Methods Uterine artery Doppler screening was performed as part of clinical practice between 22 and 24 weeks’ gestation. A resistance index (RI) was calculated from each uterine artery and the presence or absence of a notch was determined. An RI of > 0.58 was defined as abnormal and an RI of ≥ 0.7 was defined as very abnormal. The main outcome measures were: pre-eclampsia, SGA baby (birth weight < 10th centile), placental abruption, intrauterine death, ‘all’ and ‘severe’ outcomes.
Results Thirty-two (27.5%) women developed pre-eclampsia, 31 (26.7%) had SGA babies, 23 (20%) were delivered at < 34 weeks because of pregnancy complications, and there were three (2.6%) placental abruptions and three (2.6%) perinatal deaths. The sensitivity of any RI of > 0.58 for pre-eclampsia, SGA, ‘all’ outcomes and ‘severe’ outcome was 91%, 84%, 83% and 90%, respectively. The specificity of any RI of > 0.58 for these outcomes was 42%, 39%, 47% and 38%, respectively. The positive predictive value of any RI of > 0.58 for the same outcomes was 37%, 33%, 58% and 24%, respectively. Among women with both RI values of ≥ 0.7, 58%, 67%, 85% and 58% developed pre-eclampsia, SGA, ‘all’ and ‘severe’ outcomes, respectively. In women with bilateral notches, 47%, 53%, 76% and 65% developed the respective outcomes. Women with both RI values of ≥ 0.7 and women with bilateral notches had relative risks of 11.1 (95% CI 2.6–46.4) and 12.7 (95% CI 4.0–40.4) for developing severe outcome, respectively. Only 5% of women with both RI values of < 0.58 developed a severe outcome.
Conclusion In high-risk women, uterine artery Doppler waveform analysis performed best in the prediction of severe adverse outcome and was better than clinical risk assessment in the prediction of pre-eclampsia and SGA babies. Further studies are necessary to determine how information from uterine artery Doppler studies should modify current practice in high-risk women.