Transabdominal uterine arteries doppler between 11-14 weeks of gestation for prediction of outcome in high risk pregnancies

Abstract

ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia.Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation.ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks.ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. To assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. Observational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. Among 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. Normal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation.