Open AccessDiagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study
Author(s) -
D'Antonio Francesco,
Rizzo Giuseppe,
Gustapane Sarah,
Buca Danilo,
Flacco Maria Elena,
Martellucci Cecilia,
Manzoli Lamberto,
Makatsariya Alexander,
Nappi Luigi,
Pagani Giorgio,
Liberati Marco
Publication year - 2020
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13705
Subject(s) - medicine , gestation , prospective cohort study , odds ratio , obstetrics , fetus , logistic regression , umbilical artery , pregnancy , genetics , biology
To explore the strength of association and the diagnostic accuracy of umbilical ( UA ), middle cerebral ( MCA ), uterine arteries pulsatility index ( PI ) and the cerebroplacental ratio in predicting an adverse outcome when applied to singleton pregnancies at term. Material and methods Prospective study carried out in a dedicated research ultrasound clinic. Attended clinicians were blinded to Doppler findings. Inclusion criteria were consecutive singleton pregnancies between 36 +0 and 37 +6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome. Logistic regression and ROC curve analyses were used to analyze the data. Results In all, 600 consecutive singleton pregnancies from 36 weeks of gestation were included in the study. Mean MCA PI (1.1 ± 0.2 vs 1.5 ± 0.4, P < 0.001) and cerebroplacental ratio (1.4 ± 0.4 vs 1.9 ± 0.6, P < 0.001) were lower, whereas uterine arteries PI (0.8 ±0.2 vs 0.7 ±0.3, P = 0.001) was higher in pregnancies experiencing than in those not experiencing composite adverse outcome. Conversely, there was no difference in either UA PI ( P = 0.399) or estimated fetal weight centile ( P = 0.712) between the two groups, but AC centile was lower in fetuses experiencing composite adverse outcome (45.4 vs 53.2, P = 0.040). At logistic regression analysis, MCA PI ( odds ratio [OR ] 0.1, 95% CI 0.01‐.2, P = 0.001), uterine arteries PI ( OR 1.4, 95% CI 1.2‐1.6, P = 0.001), abdominal circumference centile ( OR 1.12, 95% CI 1.1‐1.4, P = 0.001) and gestational age at birth ( OR 1.6, 95% CI 1.2‐2.1, P = 0.004) were independently associated with composite adverse outcome. Despite this, the diagnostic accuracy of Doppler in predicting adverse pregnancy outcome at term was poor. Conclusions MCA PI and cerebroplacental ratio are associated with adverse perinatal outcome at term. However, their predictive accuracy for perinatal compromise is poor, and thus their use as standalone screening test for adverse perinatal outcome in singleton pregnancies at term is not supported.