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- Title
The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women.
- Authors
Harrington, K.; Fayyad, A.; Thakur, V.; Aquilina, J.
- Abstract
Objective To investigate the value of second-trimester uterine artery Doppler in the prediction of complications resulting from utero placental insufficiency in low- and high-risk multiparous women. Methods Color flow pulsed Doppler imaging of both uterine arteries at 20 weeks' gestation was performed on 628 multiparous women; 458 of them had no known risk factors and 170 had clinically identifiable high-risk factors at booking. An abnormal result was defined as bilateral notches and a mean resistance index (RI) ≥ 0.55 (50th centile) or unilateral notches and a mean RI ≥ 0.65 (80th centile). The main outcome measure was adverse pregnancy outcome defined as any case of pre-eclampsia, small-for-gestational age birth weight (<5th centile), placental abruption, stillbirth or early neonatal death. Results There was an adverse outcome in 30 women (6.6%) in the low-risk group and 48 (28.2%) women in the high-risk group. In the high-risk group the sensitivity to predict adverse pregnancy outcome in screen-positive women was 81.4% for a specificity of 89.0%, a positive predictive value of 71.4% and a negative predictive value of 93.4%. Normal Doppler studies in the high-risk group conferred a risk of adverse perinatal outcome of 6.6%, similar to the risk of adverse outcome in the low-risk population (6.6%). In the low-risk group the sensitivity for an adverse outcome in screen-positive women was 33.3% for a specificity of 92.8% and a positive predictive value of 24.4%. Conclusion In high-risk multiparous women, persistent bilateral notches with mean RI ≥ 0.55 and unilateral notches with mean RI ≥ 0.65 at 20 weeks' gestation identifies the vast majority of women who will subsequently develop complications secondary to utero placental insufficiency. Normal uterine artery Doppler studies in these women confers a risk of adverse outcome similar to that of women with an uncomplicated obstetric history. In low-risk women, the screening efficacy of uterine artery Doppler for adverse perinatal outcome is poor and does not justify routine screening.
- Subjects
PREGNANCY complications; UTERUS; PLACENTA; GESTATIONAL age; PREGNANT women
- Publication
Ultrasound in Obstetrics & Gynecology, 2004, Vol 23, Issue 1, p50
- ISSN
0960-7692
- Publication type
Article
- DOI
10.1002/uog.932