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The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women
Author(s) -
Harrington K.,
Fayyad A.,
Thakur V.,
Aquilina J.
Publication year - 2004
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.932
Subject(s) - medicine , obstetrics , uterine artery , placental abruption , gestation , pregnancy , risk factor , gestational age , gynecology , biology , genetics
Objective To investigate the value of second‐trimester uterine artery Doppler in the prediction of complications resulting from uteroplacental insufficiency in low‐ and high‐risk multiparous women. Methods Color flow pulsed Doppler imaging of both uterine arteries at 20 weeks' gestation was performed on 628 multiparous women; 458 of them had no known risk factors and 170 had clinically identifiable high‐risk factors at booking. An abnormal result was defined as bilateral notches and a mean resistance index ( RI ) ≥ 0.55 (50 th centile) or unilateral notches and a mean RI ≥ 0.65 (80 th centile). The main outcome measure was adverse pregnancy outcome defined as any case of pre‐eclampsia, small‐for‐gestational age birth weight (< 5 th centile), placental abruption, stillbirth or early neonatal death. Results There was an adverse outcome in 30 women (6.6%) in the low‐risk group and 48 (28.2%) women in the high‐risk group. In the high‐risk group the sensitivity to predict adverse pregnancy outcome in screen‐positive women was 81.4% for a specificity of 89.0%, a positive predictive value of 71.4% and a negative predictive value of 93.4%. Normal Doppler studies in the high‐risk group conferred a risk of adverse perinatal outcome of 6.6%, similar to the risk of adverse outcome in the low‐risk population (6.6%). In the low‐risk group the sensitivity for an adverse outcome in screen‐positive women was 33.3% for a specificity of 92.8% and a positive predictive value of 24.4%. Conclusion In high‐risk multiparous women, persistent bilateral notches with mean RI ≥ 0.55 and unilateral notches with mean RI ≥ 0.65 at 20 weeks' gestation identifies the vast majority of women who will subsequently develop complications secondary to uteroplacental insufficiency. Normal uterine artery Doppler studies in these women confers a risk of adverse outcome similar to that of women with an uncomplicated obstetric history. In low‐risk women, the screening efficacy of uterine artery Doppler for adverse perinatal outcome is poor and does not justify routine screening. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.