Prediction of adverse pregnancy outcomes using uterine artery Doppler imaging at 22-24 weeks of pregnancy: A North Indian experience.

Deepti Verma,Sangeeta Gupta

doi:10.4274/tjod.55632

Abstract

Objective:The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes.Materials and Methods:This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation in 165 pregnant women with singleton pregnancies. A pulsatility index (PI) more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome.Results:Out of 165 patients, 35 (21.2%) had abnormal second trimester uterine artery Doppler. In pregnancies that resulted in preeclampsia (PE), (n=21), FGR, (n=21), and low birth weight (n=39), the median uterine artery PI was higher (1.52, 1.41, and 1.27 respectively). In the presence of abnormal Doppler, the risk of PE [OR=10.7, 95% confidence interval (CI): (3.91-29.1); p<0.001], FGR [OR=4.34, 95% CI: (1.62-11.6); p=0.002], low birth weight [OR=6.39, 95% CI: (3.16-12.9); p<0.001] and the risk of at least one obstetric complication [OR=8.73, 95% CI: (3.5-21.3); p<0.001] was significantly high. The positive predictive value of abnormal uterine artery Doppler was highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.Conclusion:Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of at least one adverse pregnancy outcome, with the highest prediction for preeclampsia.

Highlights

Defective trophoblastic invasion of the spiral arteries is associated with subsequent development of preeclampsia, fetal growth restriction (FGR), and other associated complications
The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome
The test is capable of identifying pregnancies that are at premature delivery from a range of clinical complications that are attributable to chronic placental disease, namely intrauterine growth retardation, abruption and preeclampsia

Summary

Introduction

Defective trophoblastic invasion of the spiral arteries is associated with subsequent development of preeclampsia, fetal growth restriction (FGR), and other associated complications. In these pregnancies, the uteroplacental circulation remains in a state of high resistance, which causes generalized endothelial cell injury, compromises vascular integrity, and an atherosis-like process in small arteries that results in vascular occlusion, local ischemia, and necrosis. Uterine artery Doppler velocimetry performed before 16 weeks of gestation is unlikely to be a useful screening test for adverse pregnancy outcomes[5].

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Results

Conclusion