Abstract
To evaluate the value of uterine artery Doppler in predicting adverse pregnancy outcomes among women with chronic hypertension in a tertiary hospital. This is a retrospective diagnostic validity study evaluating the value of uterine artery (UA) Doppler at 18-24 weeks age of gestation in predicting adverse pregnancy outcomes among women with Chronic Hypertension (CH) in a tertiary hospital from January 1, 2012 to December 31, 2013, who delivered 24 weeks or more. CH was defined as persistent BP greater than 140/90 mmHg diagnosed before pregnancy or before 20 gestation. Abnormal UA Doppler was described as the presence of an elevated uterine artery resistance index or the presence of a diastolic notch or both. Patients diagnosed with fetal congenital anomaly, other medical problems and higher order gestation were excluded. Fifty-five % CH women had an abnormal UA Doppler and 45%of them had normal results. Among the CH patients with abnormal UA Doppler, the most common adverse pregnancy outcomes were superimposed pre-eclampsia (SPE) (57%), preterm delivery (43%), and IUGR (27%). The findings of abnormal UA Doppler has a high sensitivity of 92.6% and specificity of 63.3% for the development of SPE, with a PPV of 57% and a high negative predictive value of 94%. The positive likelihood ratio (LR) of CH women with abnormal UA Doppler to develop SPE is 2.5 higher compared to those with normal UA Doppler. Abnormal UA Doppler has a sensitivity of 38.1% and a specificity of 83.3% to have babies that are SGA with a positive LR of 2.29, PPV of 72.7% and negative predictive value of 53.6%. Abnormal UA Doppler has a low sensitivity of 5% and but a high specificity of 100% for stillbirth with a PPV 100% and negative predictive value of 46%. UA Doppler study between 18-24 weeks gestation among CH women could be a good predictor and screening tool to asses high risk women to develop adverse pregnancy outcomes especially superimposed pre-eclampsia.
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