Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies.

Abstract

The aim of this prospective study was to assess the role of uterine artery colour Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters. Various uterine artery Doppler ultrasound parameters (RI>0.58, RI>0.7 and unilateral or bilateral notching) were tested. A second objective was to compare the predictive power of uterine artery Doppler ultrasound at 19-22 gestational weeks and 23-26 weeks' gestation for an adverse pregnancy outcome. The mean time of delivery was 39+0 weeks of gestation. Eight newborns (2%) were delivered before 34 weeks of gestation. The mean birth weight was 3,240 g. Dystrophic fetuses (<10% percentile) were registered in 35 cases (10%). In 31 of the 346 women (9%) a cesarean section was performed because of abnormal fetal heart recording. Preeclampsia was diagnosed in 17 cases (5%). In 5 cases (1.4%) a placental abruption and 2 (0.6%) intrauterine fetal deaths were diagnosed. The sensitivity of notching for the prediction of preeclampsia was 88% and for the prediction of a severe pregnancy complication (preeclampsia and/or intrauterine growth retardation and/or intrauterine fetal death and/or placental abruption) at any gestational age was 62% with relative risks of 9.7 and 2.2, respectively. The sensitivity of notching for severe pregnancy complications requiring delivery before 34 weeks was 64% with a relative risk of 2.4. The sensitivity of notching in the uterine arteries for developing an IUGR was 56% with a relative risk of 1.7. The predictive value of uterine artery Doppler for adverse pregnancy outcome in a low-risk population is of limited diagnostic value. Performing uterine artery Doppler studies at 23-26 weeks' gestation instead of 19-22 weeks' gestation increases the predictive value for adverse pregnancy outcomes.