Uterine Artery Doppler Flow Velocimetry Research Articles

Correlation of uterine artery Doppler flow velocimetry and β-human chorionic gonadotropin levels during postmolar evacuation surveillance: A pilot study in a tertiary hospital

BACKGROUND: During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN). OBJECTIVE: The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole. MATERIALS AND METHODS: A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio. RESULTS: Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns. CONCLUSION: There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).

VP03.09: Correlation of uterine artery Doppler flow velocimetry and β‐hCG levels during post‐evacuation surveillance of complete mole

VP03.09: Correlation of uterine artery Doppler flow velocimetry and β‐hCG levels during post‐evacuation surveillance of complete mole

The role of clinical and laboratory tests along with uterine artery Doppler indices in the prediction of pre-eclampsia and pregnancy outcome in Egypt

Background and aim As the ideal test to predict pregnancy-induced hypertension and preeclampsia should be inexpensive, reproducible, easy to do early in pregnancy, and noninvasive and have high sensitivity, the aim of this study was to evaluate clinical parameters, laboratory tests, and uterine artery doppler indices in prediction of preeclampsia and pregnancy outcome.Patients and methods This study was carried out in the antenatal care clinic of Obstetrics and Gynecology Department of Al Azhar University Hospital. The study included 177 pregnant women booked for antenatal care before 18 weeks of gestation, who were considered to be at increased risk of developing preeclampsia.Results Doppler flow velocimetry of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and in predicting preeclampsia, when used as a single test. Microalbuminuria between 24 and 34 weeks of gestation, in the first morning urine specimen, is a good predictor for the subsequent development of preeclampsia.Conclusion When three tests were combined to test their ability to predict preeclampsia, the best triple tests were microalbuminuria, uterine artery doppler flow velocimetry study at 24–26 weeks of gestation, and mean platelet volume, which gave the highest value when κ test of agreement was used.

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

OBJECTIVES:Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia.METHODS:This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis.RESULTS:No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia.CONCLUSIONS:Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia.

Aspirin in the prevention of pre‐eclampsia in high‐risk women: a randomised placebo‐controlled PREDO Trial and a meta‐analysis of randomised trials

To study the effect of aspirin in the prevention of pre-eclampsia in high-risk women. Randomised, double-blinded, placebo-controlled trial. Maternity clinics in ten Finnish hospitals participating in the PREDO Project. A total of 152 women with risk factors for pre-eclampsia and abnormal uterine artery Doppler velocimetry. Participants were randomised to start either aspirin 100 mg/day or placebo at 12 + 0 to 13 + 6 weeks + days of gestation. Because of the limited power of this trial, we also conducted a meta-analysis of randomised controlled trials that included data on 346 women with abnormal uterine artery Doppler flow velocimetry, and aspirin 50-150 mg/day started at or before 16( ) weeks of gestation. Pre-eclampsia, gestational hypertension and birthweight standard deviation (SD) score. Outcome measures for the meta-analysis were pre-eclampsia, severe pre-eclampsia, preterm (diagnosed <37 + 0 weeks of gestation) and term pre-eclampsia. From the 152 randomised women, 121 were included in the final analysis. Low-dose aspirin did not reduce the rate of pre-eclampsia (relative risk [RR] 0.7, 95% CI 0.3-1.7); gestational hypertension (RR 1.6, 95% CI 0.6-4.2); early-onset pre-eclampsia (diagnosed <34 + 0 weeks of gestation) (RR 0.2, 95% CI 0.03-2.1); or severe pre-eclampsia (RR 0.4, 95% CI 0.1-1.3); and the results were not statistically significant in an intention-to-treat analysis. However, our meta-analysis, including the current data, suggested that low-dose aspirin initiated before 16 weeks of gestation reduces the risk of pre-eclampsia (RR 0.6, 95% CI 0.4-0.8) and severe pre-eclampsia (RR 0.3, 95% CI 0.1-0.7). Our trial showed no statistically significant effect of aspirin in preventing pre-eclampsia in high-risk women. However, our meta-analysis suggested that aspirin may reduce the incidence of pre-eclampsia.

Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women

To observe the role of uterine artery Doppler flow velocimetry at midtrimester in prediction of preeclampsia. 179 women carrying <16weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24-26weeks. Any notch in uterine artery, unilateral or bilateral, or RI>0.6, was considered abnormal. Women were followed up and development of preeclampsia noted. Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48% in high-risk and 57.14 and 95.83% in low-risk group, respectively. Relative risk with 95% confidence interval was 5.427 (2.272-12.958) in high-risk and 13.65 (5.669-32.865) in low-risk women. Doppler velocimetry of uterine artery at 24weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.

Maternal serum inhibin‐A and activin‐A levels in the first trimester of pregnancies developing pre‐eclampsia

To evaluate whether measurement of maternal serum inhibin-A and activin-A at 11 + 0 to 13 + 6 weeks of gestation, alone or in combination with second-trimester uterine artery pulsatility measured by Doppler velocimetry, is useful in predicting those women who will develop pre-eclampsia. This was a nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. Samples were collected as part of a first-trimester prenatal chromosomal anomaly screening program. Activin-A and inhibin-A were measured using a commercial enzyme-linked immunosorbent assay and the clinical outcomes were blinded to the operator. All the patients underwent uterine artery Doppler flow velocimetry to measure the mean pulsatility index at 22-24 weeks' gestation. In total there were 64 cases with pre-eclampsia, with 34 delivering prior to 35 weeks of gestation. The control group included 240 cases. In the control group the levels of activin-A and inhibin-A did not change across the narrow gestational window and the median levels were 2.16 ng/mL and 231.13 pg/mL, respectively. In the pre-eclamptic group levels of activin-A and inhibin-A were significantly increased, at 2.52 ng/mL and 286.64 pg/mL (1.24 multiples of the median (MoM) and 1.17 MoM, respectively). There was no difference in the median MoM in those delivering prior to 35 weeks and those delivering later. At cut-offs of the 90(th) centile of normal, activin-A and inhibin-A levels would have identified 20% and 35%, respectively, of cases that would develop pre-eclampsia. When combined with uterine artery Doppler, activin-A measurement could have increased the detection rate from 55% to 63% and inhibin-A measurement could have increased it to 68% at a 5% false positive rate. Although increased in the first trimester, levels of activin-A and inhibin-A are probably too low to make a significant contribution to screening for pre-eclampsia at this time.

Association Between Abnormal Uterine Artery Doppler Flow Velocimetry, Risk of Preeclampsia, and Indices of Arterial Structure and Function: A Pilot Study

Preeclampsia increases the risk of future cardiovascular disease. The association between abnormal uterine artery Doppler flow velocimetry, risk of preeclampsia, and indices of arterial structure and function is investigated in this study. The carotid intima-media thickness of 34 pregnant women with normal uteroplacental flow was compared with 30 women with abnormal uterine artery Doppler analysis during the transvaginal assessment of the uterine arteries at the routine anomaly scan (20-23 weeks of gestation). Women with abnormal uterine artery Doppler results had a greater mean internal (but not common) carotid intima-media thickness (0.58 +/- 0.06 vs 0.53 +/- 0.08, respectively, P = .005) and risk of developing preeclampsia (6 of 30 vs 0 of 34 or 20% vs 0%, respectively, P = .0079) compared with those with normal uteroplacental flow. Women with abnormal uterine artery Doppler results may be at increased risk not only for developing subsequent preeclampsia but also for future cardiovascular disease.

P41.01: Uterine arteries blood flow comparison in 11 + 0 to 13 + 6 weeks of pregnancy after natural and ART conception

To evaluate uterine arteries Doppler pulsatile index (PI) and resistance index (RI) at 11 + 0 to 13 + 6 weeks of singleton pregnancies with good known outcome after natural and assisted reproductive technologies (ART) conception, to continue this work for later retrospective analysis in cases with obstetrical complications and poor neonatal outcome with the idea to use first trimester prenatal anomalies screening program for obstetrical goals. All patients both with natural pregnancies and with pregnancies after ART conception underwent transabdominal uterine artery Doppler flow velocimetry to measure the PI and RI in addition to a first-trimester prenatal chromosomal anomaly screening program in a one-stop clinic for assessment of risk (OSCAR). After delivery, a retrospective analysis was done to compare Doppler measurements in late first trimester in pregnancies with known good outcome. There were 36 cases after natural spontaneous conception and 48 cases after ART conception The mean PI were 1.46 in spontaneous pregnancies and 1.43 in ART pregnancies. The mean RI were 0.68 in spontaneous pregnancies and 0.66 in ART pregnancies. An average newborn weight and Apgar was, respectively, 3430 g and 9 in spontaneous conception group. An average newborn weight and Apgar was, respectively, 3320 g and 9 in ART pregnancies group. These results show no differences in uterine arteries Doppler indices between groups with spontaneous and ART conception in pregnancies with known good outcome. It suggests no major differences in trophoblastic invasions between ART and natural pregnancies with good outcome. It needs to evaluate the possible differences of uterine Doppler indices in pregnancies after natural spontaneous and ART pregnancies in cases of known late obstetrical complications.

P41.08: Abnormal uterine artery Doppler flow velocimetry detected after the 34th week does not affect pregnancies complicated by fetal growth restriction

artery PI, had increased risk for Cesarean section and lower birth weight, lower gestational age at delivery, lower apgar scores and higher need for neonatal intensive care. Uterine Doppler test have a positive prediction value of 58% to predict adverse perinatal outcome and therefore it could be useful to assess SGA fetus with normal umbilical Doppler. CPR at diagnosis of SGA was not useful to assess the subsequent adverse outcome.

Effect of maternal fasting on uterine arterial blood flow

To determine the effect maternal diet pattern on the uterine artery Doppler flow velocimetry. This is a cross-sectional observational study. The uterine artery Doppler flow velocimetry was measured between 20 and 24 weeks' gestation in healthy pregnant women observing Ramadan. For each fasting mother, a non-fasting healthy pregnant woman was recruited as a control. Maternal blood glucose level was measured. A total of 106 pregnant women were studied. The mean hours since last oral intake were significantly longer, and the maternal glucose level was significantly lower in the study group than in the control group. The Mean (95% CI) of the uterine artery pulsatility index, resistance index, peak systolic velocity, end diastolic velocity and systolic/diastolic ratio was similar in both groups. Maternal fasting is not associated with significant changes in the uterine artery Doppler flow velocimetry.

Second‐trimester uterine artery Doppler pulsatility index and maternal serum PP13 as markers of pre‐eclampsia

To evaluate whether measurement of maternal serum PP13 at 22 to 24 weeks of gestation, alone or in combination with second-trimester biochemical markers or uterine artery pulsatility measured by Doppler velocimetry, is useful in predicting those women at risk of developing pre-eclampsia. A nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. PP13 was tested by an ELISA, with the samples blinded to pregnancy outcome. All patients also underwent uterine artery Doppler flow velocimetry at 22-24 weeks to measure the mean pulsatility index (PI). Results for Inhibin, Activin, PAPP-A and Free beta-hCG were available from previous studies. There were 73 controls and five cases with early pre-eclampsia in which delivery was induced prior to 35 weeks. In addition, there were a further seven cases with pre-eclampsia in which delivery was not induced before term. Median PP13 levels for controls and all cases were 295.9 and 212.6 pg/ml, and 171.2 pg/ml amongst the early pre-eclampsia cases, with the MoMs 1.00, 0.94 and 0.63, respectively (p < 0.001). Receiver operator characteristic (ROC) curve analysis for either all cases or early cases versus controls yielded areas under the curve of 0.588 (95% CI: 0.42-0.76; p = 0.1526) and 0.693 (0.47-0.92; p = 0.0441) for PP13. At a specificity set to 0.80, the sensitivity for PP13 in the early cases was 0.40 and that in all cases was 0.25. Combining PP13 bivariately with any of the markers (PI, PAPP-A, Activin, Inhibin or Free beta-hCG) tested in the 22-24 week period did not improve the detection of early, late or all cases of pre-eclampsia compared with either marker alone. Late second-trimester PP13 alone is unlikely to be useful in predicting pre-eclampsia and early pre-eclampsia, and its prediction does not increase when coupled with second-trimester Doppler PI or other potential biochemical markers. Measuring between-trimester temporal changes may be worthy of further investigation.

Maternal Uterine Artery Doppler Flow Velocimetry and the Risk of Stillbirth

We sought to relate the risk of antepartum stillbirth to uterine artery Doppler flow velocimetry at 22-24 weeks. Data were available from 30,519 unselected women from seven units in the UK who had uterine artery Doppler performed between 22 and 24 weeks of gestation. The risk of stillbirth (n=109) was assessed using time to event and logistic regression analysis. Stillbirths were subdivided into placental (due to abruption, preeclampsia, or growth restriction) or unexplained. The risk of placental stillbirth was increased among women with a mean pulsatility index in the top decile (adjusted hazard ratio [HR] 5.5, 95% confidence interval [CI] 2.8-10.6) and those with a bilateral notch (adjusted HR 3.9, 95% CI 2.0-7.8). The relationship between a mean pulsatility index in the top decile and the risk of unexplained stillbirth was weaker (adjusted HR 2.5, 95% CI 1.1-5.6) and there was no association with a bilateral notch. Placental stillbirths occurred at earlier gestations than unexplained stillbirths (median [interquartile range] 30 [26-36] compared with 38 [36-40], P<.001). Consequently, being in the top 5% of predicted risk of stillbirth on the basis of the combination of mean pulsatility index and notching was a good predictor (sensitivity, specificity, and positive likelihood ratio) of all cause stillbirth up to 32 weeks (58%, 95%, and 12.1, respectively) but a poor predictor of stillbirth at later gestations (7%, 95%, and 1.3, respectively). Abnormal uterine artery Doppler was a better predictor of the risk of stillbirth due to placental causes than unexplained stillbirth. Consequently, abnormal uterine artery Doppler was a good predictor of stillbirth at extreme preterm gestations but a poor predictor of stillbirth at term. II.

First‐trimester maternal serum PP‐13, PAPP‐A and second‐trimester uterine artery Doppler pulsatility index as markers of pre‐eclampsia

To evaluate whether measurement of maternal serum placental protein-13 (PP-13) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks of gestation alone or in combination with second-trimester uterine artery pulsitility measured by Doppler velocimetry is useful in predicting those women who will develop pre-eclampsia This was a nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. Samples were collected as part of a first-trimester prenatal chromosomal anomaly screening program and were routinely tested for PAPP-A. PP-13 was tested using an enzyme linked immunosorbent assay (ELISA) by an examiner who was blinded to pregnancy outcome. All patients also underwent uterine artery Doppler flow velocimetry to measure the mean pulsatility index (PI) at 22-24 weeks' gestation. There were 446 controls and 44 cases with early pre-eclampsia where delivery was induced prior to 35 weeks. In addition there were a further 44 cases with pre-eclampsia in which delivery was not induced before term. Median PP-13 levels for controls, all cases and early pre-eclampsia cases were 176.9, 121.9 and 111.7 pg/mL, with multiples of the median (MoMs) of 1.00, 0.69 and 0.63, respectively (P < 0.001). PAPP-A MoMs were 1.00, 0.89 (P = 0.076) and 0.89 (P = 0.042) and mean PIs were 1.0, 1.6 (P < 0.001) and 1.7 (P < 0.001) for controls, all cases and early cases, respectively. Receiver-operating characteristics (ROC) curve analysis for either all cases or early cases vs. controls yielded areas under the curve for PP-13, PAPP-A and PI respectively of 0.68 (95% CI, 0.61-0.74; P < 0.001), 0.56 (95% CI, 0.49-0.63; P = 0.076) and 0.79 (95% CI, 0.72-0.87; P < 0.001) for all cases and 0.71 (95% CI, 0.63-0.79; P < 0.001), 0.59 (95% CI, 0.51-0.68; P = 0.076) and 0.86 (95% CI, 0.77-0.94; P < 0.001) for early cases. At a specificity set to 0.80 the sensitivities were 0.50, 0.23 and 0.76 for PP-13, PAPP-A and PI in the early cases and 0.44, 0.24 and 0.73 in all cases. Combining PP-13 and PI using logistic regression analysis yielded an area under the curve of 0.84 (95% CI, 0.78-0.90; P < 0.001) and a sensitivity of 0.74 in all cases, and 0.90 (95% CI, 0.84-0.96; P < 0.001) and a sensitivity of 0.79 for early cases. PAPP-A with PI gave an area under the curve of 0.82 (95% CI, 0.76-0.90; P < 0.001) and a sensitivity of 0.76 in all cases. Combining PAPP-A with PP-13 and PI did not add significantly to the sensitivity. First-trimester PP-13 levels may be useful in predicting pre-eclampsia and early pre-eclampsia, and the accuracy of the method increases when coupled with second-trimester Doppler PI measurement. First-trimester PAPP-A provides some prediction for pre-eclamspia when combined with PI but does not add to the prediction of early pre-eclampsia when PP-13 and PI are used together. Further studies are required to establish the real value of PP-13 in first-trimester screening for pre-eclampsia.

Maternal serum PP13 and PAPP-A in first trimester, and doppler in second trimester, as markers of pre-eclampsia

To evaluate serum PP-13 and PAPP-A at 11-13 weeks of gestation, and second trimester Doppler, as markers for pre-eclampsia (PET). A nested case-control study of PET Cases vs. Controls matched for gestational age and storage time. Samples were collected as part of a first trimester Prenatal Chromosomal Anomaly screening programme and were routinely tested for PAPP-A. PP-13 was tested blind to pregnancy outcome. All patients also underwent 22-24 week uterine artery Doppler flow velocimetry (mean Pulsatility index). There were 446 Controls and 88 PET Cases in the study. Median PP-13 levels for Controls and Cases were 176.9 and 121.9 (MoMs = 1.00 and 0.69) respectively (P < 0.001). PAPP-A MoMs were 1.0 and 0.89 (P = 0.076) and Doppler PIs were 1.0 and 1.6 (P < 0.001) for Controls and Cases respectively. Receiver operating characteristic (ROC) curve analysis for Cases vs. Controls yielded areas under the curve (AUCs) for PP-13, PAPP-A and Doppler respectively of 0.68 (95% CI: 0.61 to 0.74; P < 0.001), 0.56 (0.49 to 0.63; P = 0.076), and 0.79 (0.72 to 0.87; P < 0.001). Using each marker by itself and setting specificity at 0.80 gave sensitivities of 0.44, 0.24 and 0.73 for PP-13, PAPP-A and Doppler respectively. Combining PP-13 and Doppler using logistic regression yielded an AUC of 0.84 (0.78 to 0.90; P < 0.001) and sensitivity of 0.74. PAPP-A with Doppler gave an AUC of 0.82 (0.76 to 0.89; P < 0.001) and sensitivity of 0.76. Combining all markers did not add significantly to combining each serum marker with Doppler. First trimester PP-13 may be useful in predicting early PET, its accuracy increasing when coupled with second trimester Doppler. First trimester PAPP-A provides some prediction for PET, its prediction similarly increasing when combined with Doppler.

How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview.

To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre-eclampsia and its associated complications of intrauterine growth retardation and perinatal death. Quantitative systematic review of observational diagnostic studies using online searching of the MEDLINE database coupled with scanning of the bibliographies of primary and review articles including known unpublished studies. Twenty-seven studies involving 12,994 subjects stratified into population subgroups at low and high risk of developing pre-eclampsia and its complications. The outcome measures studied were: 1. the development of pre-eclampsia; 2. intrauterine growth retardation; and 3. perinatal death. The main meta-analyses were the flow velocity waveform ratio +/- diastolic notch derived by transabdominal Doppler ultrasound as the measurement parameter. The analyses were conducted using likelihood ratio as a measure of diagnostic accuracy. A likelihood ratio of 1 indicates that the test has no predictive value for the outcome. Prediction for the outcome event is considered conclusive with likelihood ratios of > 10 or < 0 x 1 for a positive and negative test result, respectively. Moderate prediction can be achieved with likelihood ratios of 5-10 and 0 x 1-0 x 2 whereas likelihood ratios values of 1-5 and 0 x 2-1 would generate only minimal prediction. In the low risk population a positive test result, predicted pre-eclampsia with a pooled likelihood ratio of 6 x 4 (95% CI 5 x 7-7 x 1), while a negative test result had a pooled likelihood ratio of 0 x 7 (95% CI 0 x 6-0 x 8). For intrauterine growth retardation the pooled likelihood ratio was 3 x 6 (95% CI 3 x 2-4 x 0) for a positive test result and 0 x 8 (95% CI 0 x 8-0 x 9) for a negative test result. Using perinatal death as outcome measure, the pooled likelihood ratio was 1 x 8 (95% CI 1 x 2-2 x 9) for a positive test result and 0 x 9 (95% CI 0 x 8-1 x 1) for a negative test result. In the high risk population a positive test result predicted pre-eclampsia with a pooled likelihood ratio of 2 x 8 (95% CI 2 x 3-3 x 4), while a negative test had a likelihood ratio of 0 x 8 (95% CI 0 x 7-0 x 9). For intrauterine growth retardation the pooled likelihood ratio was 2 x 7 (95% CI 2 x 1-3 x 4) for a positive test result and 0 x 7 (95% CI 0 x 6-0 x 9) for a negative result. For perinatal death the pooled likelihood ratio was 4 x 0 (95% CI 2 x 4-6 x 6) for a positive test result and 0 x 6 (95% CI 0 x 4-0 x 9) for a negative result. Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting pre-eclampsia, intrauterine growth retardation and perinatal death.