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The role of Doppler velocimetry in the structurally normal second‐trimester fetus with elevated levels of maternal serum α‐fetoprotein
Author(s) -
Bromley B.,
Frigoletto F. D.,
Harlow B. L.,
Pauker S.,
Benacerraf B. R.
Publication year - 1994
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 - 10.1046/j.1469-0705.1994.04050377.x
Subject(s) - medicine , uterine artery , umbilical artery , diastole , obstetrics , velocimetry , cardiology , fetus , incidence (geometry) , pregnancy , blood pressure , artery , laser doppler velocimetry , blood flow , gestation , genetics , physics , optics , biology
Umbilical and uterine artery velocimetry was performed in 199 second‐trimester pregnancies undergoing sonographic examination for unexplained elevated levels of maternal serum α‐fetoprotein in order to evaluate the efficacy of Doppler waveforms for the prediction of adverse perinatal outcome. A total of 169 pregnancies resulted in term deliveries of infants with appropriate growth for age, and 30 pregnancies (15%) had adverse outcomes, including preterm delivery, growth retardation and death. The umbilical artery systolic/diastolic ratio was not statistically different in the two groups (3.9 vs. 4.2, p = 0.16). The uterine artery systolic/diastolic ratio was slightly greater in the group with abnormal outcome (5.7) than in the group with normal outcome (3.3), but the difference was not significant ( p = 0.11). Forty‐six patients had uterine artery waveforms that exhibited an early diastolic notch. Of these, 31 had a grade 1 notch in which the lowest part of the notch was not greater than one half of the diastolic frequency shift. Fifteen patients had a severe or grade II notch in which the deepest part of the diastolic notch was less than half of the diastolic flow. In patients with either no diastolic or grade I uterine artery notch, the incidence of adverse outcomes was 23/184 (12.5%). In patients with a grade II notch, 7/15 (47%) had a poor outcome. The rate of adverse outcome in patients with a grade II notch was more than three times that observed in women without severe uterine notch, yielding a relative risk of 3.4 (95% CI 1.9–6.0). Thus, the presence of a grade II uterine artery notch on second‐trimester sonographic evaluation is associated with an increased risk for adverse perinatal outcome over unexplained elevated levels of maternal serum α‐fetoprotein. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology