Screening for Placental Insufficiency by Transvaginal Uterine Artery Doppler at 22–24 Weeks of Gestation

Abstract

Objective: To determine the value of routine transvaginal color Doppler assessment of the uterine arteries at 22–24 weeks of gestation in the prediction of placental insufficiency. Methods: Women with singleton pregnancies scheduled for routine ultrasound scans at 22–24 weeks were offered Doppler assessment of the uterine arteries by transvaginal ultrasound. The pulsatility index (PI) was obtained for each artery and the mean value was calculated. A mean PI >95th percentile was considered increased. Screening characteristics for predicting placental insufficiency, defined as preeclampsia, fetal growth restriction or intrauterine death, were calculated. Results: Doppler examination of the uterine arteries was carried out in 1,057 singleton pregnancies. The mean uterine artery PI was 1.03 and the 95th percentile was 1.55. In 54 cases (5.1%) the mean PI was >1.55 (screen-positive). In the study population there were 48 cases of preeclampsia (5.1%), 72 fetal growth restrictions (7.5%) and 7 intrauterine deaths (0.7%). The screen-positive group showed an incidence of 47.1% of combined adverse results. The relative risks after a positive screening test were 7.3 (CI 4.2–12.6) for pre-eclampsia, 3.9 (CI 2.3 – 6.6) for fetal growth restriction and 4.5 (CI 3.2–6.4) for overall placental insufficiency. Conclusions: Uterine artery Doppler at 22–24 weeks identifies women at higher risk for the development of subsequent complications of placental insufficiency. This test could be used in combination with other markers to stratify the level of care offered in the third trimester of pregnancy.

Prediction of Pre-Eclampsia by a Combination of Maternal History, Uterine Artery Doppler, and Mean Arterial Pressure (A Prospective Study of 200 Cases)

“…6 weeks of gestation subjects who delivered an AGA baby was significantly less as compared to the values in women who delivered a SGA baby. Palma-Dias et al [14] in a study on 954 subjects have shown the screening test characteristics of mean PI [ 1.55. The sensitivity varied from 18.1 % for FGR to 29.2 % for pre-eclampsia.…”

Doppler Sonography of Uterine Arteries at 20–23 Weeks: Depth of Notch Gives Information on Probability of Adverse Pregnancy Outcome and Degree of Fetal Growth Restriction in a Low-Risk Population

“…Several maternal aspects, like race, smoking, nulliparity, primipaternity, family or personal history of pre-eclampsia or hypertension [24] , higher BMI and higher maternal age [25] are considered to be associated with an elevated risk of APA. Beside these maternal background factors, new approaches use maternal serum values in combination with other parameters to predict complications [26][27][28][29] .…”

“…Two parameters are in use for such risk assessment: impedance and presence of notch. While some authors only use the impedance [3,[24][25][26][30][31][32] or the presence of a notch [33][34][35][36][37][38][39] , others choose a combination of both parameters [40][41][42][43][44] .…”

Colour Doppler in IUGR- Where are we and where do we go?

“…Numerous studies have shown that late first trimester screening of the uterine artery in high-risk women can accurately identify a subset of women who are destined for major complications that will be attributable to placental disease. Serial Doppler assessment of the uterine artery is performed from the 16th wk onwards in these high risk women who may have history of factors known to cause IUGR 25,26 . The persistence of the pre-diastolic notch and gradually increasing impedance indices suggest an abnormal uterine circulation and hence is an indicator to treat these women with bed rest, antihypertensives and oxygen therapy right from the onset of the pathology.…”