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Colour Doppler Imaging of the Uteroplacental Circulation in the Mid‐Trimester: Features of the Uterine Artery Flow‐Velocity Waveform that Predict Abnormal Pregnancy Outcome
Author(s) -
Fay Roger A.,
Ellwood David A.,
Bruce Suzanne,
Turner Anne
Publication year - 1994
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1994.tb01098.x
Subject(s) - medicine , pregnancy , uterine artery , obstetrics , preeclampsia , notching , prospective cohort study , aspirin , gynecology , gestation , genetics , materials science , metallurgy , biology
EDITORIAL COMMENT: We accepted this paper for publication because it presents data on the use of colour Doppler imaging in a screening test in healthy nulliparas to assess whether abnormal pregnancy outcome can be identified. Unexpectedly there were 4 perinatal deaths in this series and table 4 indicates that in the only case in which the perinatal death was potentially avoidable the 24‐week uterine Doppler studies were normal. There is mounting evidence that Doppler imaging of uteroplacental circulation is useful in the management of identified high‐risk pregnancies but the value of the method as a screening test remains unproven. If larger studies confirm the reliability of this investigation to detect patients who are destined to develop preeclampsia then a possible application of this is identification of women who warrant prophylactic aspirin therapy since recent results show that aspirin therapy is not indicated routinely in nulliparas Summary: The accuracy of raised Resistance Index (RI) and early diastolic notching (EDN) of mid‐trimester uterine artery flow velocity waveforms in predicting abnormal pregnancy outcome was assessed in a prospective longitudinal study using colour Doppler imaging at 14, 18, and 24 weeks. In 106 healthy nulliparas with a singleton pregnancy studied; 70 had a normal pregnancy outcome, 34 had an abnormal pregnancy outcome, and 2 were lost to follow‐up. EDN was more sensitive than raised RI at predicting subsequent abnormal pregnancy outcome but raised RI was more specific at 14 and 18 weeks. Sensitivities were highest for the pregnancies with the more severely abnormal outcomes. Uterine artery Doppler studies in the mid‐trimester can predict abnormal pregnancy outcome. The presence of an early diastolic notch is an important feature when defining an abnormal or high resisitance uteroplacental circulation.