Prediction of pre‐eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women

Abstract

Objective To assess the performance of four previously reported Doppler abnormalities of uterine artery velocity waveforms (presence of a protodiastolic notch, peak systolic over protodiastolic velocities (A:C ratio) > 2.5, peak systolic over end diastolic velocities (A:B ratio) > 90th centile, resistance index (RI) ([A-B]/A) 2 0.58) in predicting pre-eclampsia, low birthweight and prematurity.Design Prospective cohort study.Setting Tertiary care university hospital in Quebec City.Population 13 1 1 nulliparous women.Methods Evaluation of pulsed Doppler abnormalities of uterine artery velocity waveforms was carried out in 1000 and 1 194 of women at 18.3 (SD 0.9) or 26.7 (SD 0.9) weeks of pregnancy.Main outcome measures Pre-eclampsia, birthweight below the 10th centile for gestational age and spontaneous preterm birth (< 37 completed gestation weeks).Results Pre-eclampsia, low birthweight for gestation and prematurity occured in 4%, 1 1% and 7% of the pregnancies, respectively. At 26 weeks all the abnormalities of the studied Doppler indices were significantly associated with pre-eclampsia and low birthweight for gestation as reflected by the 95% confidence intervals of the positive likelihood ratios which did not include the value 1. However, sensitivities (26% to 34%) and positive predictive values (7% to 28%) were low. No Doppler indices performed significantly better than the others. The abnormalities of the Doppler indices were not associated with spontaneous prematurity. The performance of the Doppler measurements performed at 18 weeks was poor.Conclusions Uterine artery Doppler velocimetry waveform analysis does not qualify as a reliable screening test for pre-eclampsia or low birthweight for gestation in low risk pregnancies but may be useful in selected high risk populations.

The value of colour doppler assessment of the uteroplacental circulation in predicting intrauterine growth restriction

“…Eight patients with IUGR, which was predicted by abnormal uterine artery Doppler in 5 cases with sensitivity of 37.5%, 25% and 50% for S/D ratio, RI and Notch respectively which is similar to findings of Irion et al, North et al, and Bower et al [10][11][12] the sensitivity was 93.48%, 94.56% and 95.65% for S/D ratio, RI and Notch respectively. The Positive predictive value (PPV) of Notch was 50%, which was highest.…”

Impaired uteroplacental blood flow in pregnancies complicated by falciparum malaria

“…This is supported by the observation that some women with initially normal Doppler FVW went on to develop abnormalities in association with later malaria infection. In non-malarious areas, only 1% of women with normal waveforms at 18 weeks of gestation have been reported to develop notched waveforms subsequently 27 , whereas 10% of women with normal waveforms after 24 weeks went on to develop notching later in the third trimester in our study. Pro-inflammatory cytokines, including tumor necrosis factor-α, interferon-γ and interleukin-2 are produced in the placenta during active malaria infection 28 .…”

Implication of an AGT Haplotype in a Multigene Association Study With Pregnancy Hypertension

“…38 This process has been used since 1987 in the perinatal research unit in the course of other cohort studies, and no significant discrepancy occurred when compared with clinical assessment by 2 clinicians. 45,46 Third, our study was conducted in nulliparous women, a clinically more homogenous population of cases of preeclampsia. Fourth, matching of cases and control subjects for several known risk factors of preeclampsia and/or essential hypertension minimized the influence of confounding factors.…”