Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre‐eclampsia

Aquilina, J.; Barnett, Adrian; Thompson, Olaleye; Harrington, Kevin

doi:10.1046/j.1469-0705.2000.00217.x

Cited by 52 publications

(37 citation statements)

References 24 publications

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“…A screen-positive or abnormal result was defi ned as bilateral notches and a mean RI 1 0.55 (50th centile), unilateral notches and a mean RI 1 0.65 (80th centile), and absence of notches and a mean RI 1 0.7 (95th centile) [25] . Women with these abnormal results were offered growth scans, amniotic fl uid volume assessment, and umbilical artery Doppler every 4 weeks until 36 weeks in view of the recognized increased risk of isolated IUGR [24][25][26][27][28] , unless there were other clinical indications which necessitated closer surveillance.…”

Section: Methodsmentioning

confidence: 99%

Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction

Önalan¹,

Önalan²,

Gunenc

et al. 2006

Gynecol Obstet Invest

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Aim: To evaluate the efficacy of a combined 2nd-trimester maternal serum homocysteine and uterine artery Doppler screening at 20 weeks of gestation for complications of pregnancy: preeclampsia, isolated intrauterine growth restriction (IUGR), placental abruption, and stillbirths. Methods: Consecutive singleton pregnancies without previous risk factors who had homocysteine measured as part of a serum-screening program for trisomy 21 had uterine artery Doppler performed. Sensitivity, specificity, positive and negative predictive values, odds ratio, and positive and negative likelihood ratios for the subsequent development of preeclampsia, isolated IUGR, placental abruption, stillbirth, and preterm delivery were calculated for the following methods (1) homocysteine cutoff level 6.3 µmol/l (95th centile); (2) on Doppler ultrasound bilateral notches with a mean resistance index (RI) >0.55 (50th centile), all unilateral notches with a mean RI >0.65 (80th centile), and absence of notches with a mean RI >0.7 (95th centile), and (3) Doppler ultrasound notch evaluation (bilateral, unilateral, absence as in method 2) combined with the homocysteine cutof level of 6.3 µmol/l. Results: By using a logistic regression model, methods 1 and 2 predicted preeclampsia (p < 0.001), isolated IUGR (p < 0.01), and ‘any complication’ (p < 0.01). The sensitivity for prediction of preeclampsia using the combined method (3) was 61.3% for a false-positive rate of 2%, better than that for isolated IUGR (54%) below the 5th centile and ‘any complication’(56%). Conclusion: This prospective study confirms the potential of a combined method of elevated homocysteine and uterine artery Doppler screening for preeclampsia, isolated IUGR, and any obstetric complication.

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Section: Methodsmentioning

confidence: 99%

Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction

Önalan¹,

Önalan²,

Gunenc

et al. 2006

Gynecol Obstet Invest

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“…He said that it is best screening method if further screening, later in pregnancy is proposed. 6 In a study by Barati M et al, in the case of 'small for gestational age' it had to have a specificity of 96.5%, a sensitivity of 57%, an NPV of 99.2% and a PPV of 23.5%. 7 In a study by Papageorghiou et al, the sensitivity of increased pulsatility index above the 95th centile for pre-eclampsia with fetal growth restriction was 69%, for pre-eclampsia without fetal growth restriction was 24%.…”

Section: Efficiency Of Testmentioning

confidence: 99%

Role of uterine artery Doppler in prediction of FGR in high risk pregnancies in 20-24 weeks

Dave

Joshi

Sooruthiya

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Accurate prediction of fetal growth retardation (FGR) is a long-sought goal of perinatology as it contributes significantly to perinatal mortality and morbidity. It generally manifest later in pregnancy, their underlying pathophysiology is largely established early in pregnancy. Early detection will help in decreasing the associated morbidity.Methods: The study was carried out on 100 pregnant women of 20-24 weeks gestation in the Department of Obstetrics and Gynecology, MGM Medical College and MY Hospital, Indore from March 2015 to February 2016.Presence of diastolic notch in uterine artery waveform was taken as screen positive.Results: Total Diastolic notch positive cases 20/100 out of which 60% developed FGR and 80/100 Diastolic notch negative cases out of which only 4 cases (5%) will developed FGR. The sensitivity of the test was 75% while the specificity was 90.47%. The positive predictive value was 60% while the negative predictive value was 89.74%. 50% of screen positive belonged to 30-39 year age group and 68.75% FGR was seen in primiparous.Conclusions: Study of uterine artery flow velocity waveform seems to be a modern technique which can be used for ruling out the probability of FGR. Presences of diastolic notch in uterine vessels in 2nd trimester are of prognostic value for maternal complications and fetal jeopardy and therefore need of further critical assessment and management.

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“…The A/C ratio was complementary to bilateral notches when the false-positive rate was set at 17% and an effective quantitative substitute when the falsepositive rate was set at 11%. 15 Reduced amniotic fluid clinically named as oligohydramnios is one more known manifestation of obstetric vasculopathies. It is an accompanying manifestation os preeclampsia and or IUGR.…”

Section: Diastolic Notch In Combination With Other Indicesmentioning

confidence: 99%

Predicting Obstetric Vasculopathies through Study of Diastolic Notch and other Indices of Resistance to Blood Flow in Uterine Artery

Desai¹

2013

International Journal of Infertility &Amp; Fetal Medicine

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Obstetric vasculopathies are a set of apparently heterogeneous and poorly understood conditions. Conditions like recurrent miscarriages due to fetal demise, pre-eclampsia, IUGR, recurrent still births and accidental hemorrhage all seem to have the same underlying etiopathology. They are grouped into one large set coined as 'Obstetric Vasculopathies'. Resistance to blood flow in the uterine arteries can be important and effective method to predict obstetric vasculopathies (except recurrent miscarriages). Resistance to this blood flow can be measured by the presence (and subsequent disappearance) of diastolic notch as well as the standard color Doppler indices namely Pulsatility Index (PI), Resistance Index (RI) and Systolic: Diastolic (S: D) ratio. In normal pregnancy almost always at 12 to 14 weeks of duration, the uterine artery shows presence of a diastolic notch. In high-risk subjects, disappearance of diastolic notch at midtrimester in uterine artery Doppler waveform analysis if used alone may not be a good screening method for obstetric vasculopathies. However, the combination of a diastolic notch and an abnormal resistance index in both uterine arteries at 20 weeks gestation is more accurate indicator in predicting severe pregnancy complications. These subjects are almost eight times more likely to develop either: Clinically significant hypertension and/or deliver prior to 32 weeks and/or have a perinatal demise and/or have an Infant with a birth weight of less than 1500 gm. Bilateral or Unilateral: Studying bilateral uterine artery seems to be more accurate that unilateral artery for prediction of obstetric vasculopathies. Prediction in I-Trimester: Disappearance of uterine artery diastolic notch in combination with other parameters seems to be a good test for prediction of obstetric vasculopathies particularly PIH and IUGR in I-Trimester. The advantage of such an early allows an early instituting of preventive measures. Notch Depth Index (NDI): It is calculated as the depth of the diastolic notch divided by the maximal diastolic velocity. The NDI value in the second trimester is associated with the later onset of pre-eclampsia, and is clinically more useful in predicting pre-eclampsia than the two conventional indices. Abnormal maternal uterine artery Doppler in association with elevated maternal serum AFP, HCG, Inhibin A or decreased PAPP-A identifies a group of subjects at greater risk of IUGR and gestational hypertension with proteinuria. Lowdose aspirin administered as early as 14 to 16 weeks of gestation to pregnant subjects at high risk of pre-eclampsia with abnormal uterine Doppler findings may reduce or modify the course of severe pre-eclampsia and may help in prevention of IUGR.

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Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre‐eclampsia

Cited by 52 publications

References 24 publications

Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction

Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction

Role of uterine artery Doppler in prediction of FGR in high risk pregnancies in 20-24 weeks

Predicting Obstetric Vasculopathies through Study of Diastolic Notch and other Indices of Resistance to Blood Flow in Uterine Artery

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