Doppler ultralsound of the uterine arteries: the importance of bilateral notching in the prediction of pre‐eclampsia, placental abruption or delivery of a small‐for‐gestational‐age baby

Abstract

The use of Doppler studies of the uterine arteries in the prediction of pre-eclampsia and intrauterine growth retardation has had mixed success. The introduction of color Doppler imaging and the use of the "notch' to define an abnormal waveform have helped to improve the predictive value of uterine artery Doppler screening. The aim of this study was to evaluate the use of uterine artery Doppler in a group of women of mixed race and parity. This study was a prospective, cross-sectional analysis of 1326 unselected women who were screened with continuous wave uterine Doppler at 19-21 weeks, as part of a fetal anomaly/dating scan. A total of 214 women with abnormal uterine artery waveforms (notching) were referred for assessment at 24 weeks; 191 attended and had color Doppler imaging/pulsed Doppler studies of both uterine arteries. Data from 185 pregnancies were suitable for analysis. There were abnormal uterine Doppler findings (uni- or bilateral notching) in 110 patients at 24 weeks; 48 had bilateral notching. The sensitivity of notching for the prediction of proteinuric pregnancy-induced hypertension (PPIH) was similar in primiparas (76.9%), multiparas (77.7%), African-Caribbean women (82.6%) and Caucasian women (71.4%). The sensitivity of bilateral notching for the prediction of PPIH requiring delivery before 34 weeks was 81.2%, and 57.6% for babies small for gestational age (SGA), with positive predictive values of 27% (PPIH), 31.2% (SGA) and 37.5% (any complication). Patients with persistent bilateral notching are particularly at risk of developing PPIH or delivering an SGA baby before 34 weeks' gestation; they warrant increased surveillance, and may be a group that could benefit from prophylactic therapies.

Impaired uteroplacental blood flow in pregnancies complicated by falciparum malaria

“…The association between abnormal uterine artery Doppler FVW and measures of bad obstetric outcome (PET, LBW and perinatal death) is in keeping with other studies 12,18,23,24 . Abnormalities of uterine artery Doppler FVW, persisting after 24 weeks of gestation, are predictive of subsequent pregnancy complications, including PET and IUGR 12,25 .…”

“…Abnormalities of uterine artery Doppler FVW, persisting after 24 weeks of gestation, are predictive of subsequent pregnancy complications, including PET and IUGR 12,25 . Highly abnormal Doppler FVW are most strongly associated with poor outcome but bilateral uterine artery notching alone is also associated with increased risk of poor pregnancy outcome (Figure 2) 24 .…”

Routine uterine artery Doppler screening in twin pregnancies?

“…In singleton pregnancies, there is now extensive literature reporting on the clinical utility of mid-trimester uterine artery Doppler examination, in both high-risk and unselected populations, summaries of which suggest that this technique can predict the development of subsequent PET and IUGR with sensitivities of around 50% and 30%, respectively, for a 5% screen-positive rate, depending upon criteria used [3][4][5][6][7] . This information allows rational risk stratification for planning of further antenatal care and identifies a high-risk group for use in intervention studies, such as those examining the effectiveness of low-dose aspirin in prevention of PET 8 .…”

Hemodynamic Prediction and Stratification of Hypertensive Disorders of Pregnancy: A Dream That Is Coming True?

“…To date, the prediction of these disorders and their complications has been based on many clinical characteristics, hemodynamics, and placental indicators (either with Doppler evaluation of uterine artery and/or levels of circulating angiogenic proteins) 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Early identification of asymptomatic women more likely to develop HDP and other complications would help clinicians in planning appropriate monitoring during pregnancy, potentially treating the condition with preventive strategies before the blood pressure actually increases, and with a possible delay or mitigation of its consequences.…”

“…The first one has been the uterine artery Doppler interrogation in the second trimester, and has been introduced since the past 2 decades of the past century 1. Lately, biochemical and central hemodynamic parameters have been used to refine and improve the classification and the prediction of HDP 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13…”