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Uterine artery Doppler and adverse pregnancy outcome in women with extreme levels of fetoplacental proteins used for Down syndrome screening
Author(s) -
Filippi E.,
Staughton J.,
Peregrine E.,
Jones P.,
Huttly W.,
Peebles D. M.,
Pandya P.,
David A. L.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8901
Subject(s) - medicine , placental abruption , obstetrics , pregnancy , uterine artery , small for gestational age , population , pregnancy associated plasma protein a , gestation , gynecology , miscarriage , first trimester , genetics , environmental health , biology
Objective To evaluate the use of second‐trimester uterine artery (UtA) Doppler to predict adverse pregnancy outcome in women with extreme levels of fetoplacental proteins used for Down syndrome screening. Methods At a single institution, women screened for Down syndrome were offered second‐trimester UtA Doppler examination if they had one of the following on analysis of maternal serum: pregnancy‐associated plasma protein‐A ≤ 0.28 multiples of the median (MoM) (1% of screened population), inhibin ≥ 3.0 MoM (2%), human chorionic gonadotropin ≥ 4.0 MoM (2%), alpha‐fetoprotein (AFP) ≥ 2.5 MoM (2%), estriol ≤ 0.5 MoM (1%). Abnormal UtA Doppler was defined as bilateral or unilateral notching or mean pulsatility index ≥ 1.45. Results Of 240 women studied, 92 (38.3%) had an adverse pregnancy outcome: small for gestational age (either < 10 th customized centile ( SGA 10 ) or < 5 th customized centile (SGA 5 )), low birth weight (LBW, < 2.5 kg), preterm delivery (< 37 + 0 weeks of gestation), fetal loss (late miscarriage or stillbirth), placental abruption and gestational hypertension. Of 167 women screened with all five hormones, those with two or more extreme levels ( n = 18, 10.8%) were significantly at risk of adverse pregnancy outcome compared with those with only one marker (61.1% vs. 35.6%, P = 0.04). UtA Doppler was abnormal in 20% (32 of 159 women screened) and increased the risk of adverse pregnancy outcome (RR 2.5, 65.6% vs. 26.0%, P < 0.001). SGA 10 , SGA 5 and LBW were significantly more common in women with abnormal UtA Doppler (RR 2.98, 56.2% vs. 18.9%, P < 0.001, RR 4.6, 43.7% vs. 9.4%, P < 0.001 and RR 4.4, 31.2% vs. 7.1%, P < 0.001, respectively). Women with normal Doppler examination still had a 26% risk of adverse pregnancy outcome. Conclusions In women with extreme levels of feto‐placental proteins used for Down syndrome screening, an abnormal second‐trimester UtA Doppler examination confers a high risk of adverse pregnancy outcome and SGA in particular, but a normal examination does not rule out an adverse pregnancy outcome. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.