The role of color Doppler imaging of the uterine arteries at 20 weeks' gestation in stratifying antenatal care

Abstract

ObjectiveTo determine the value of one-stop color Doppler imaging of the uterine arteries at the time of the 20-week anomaly scan, to select women at risk of developing pre-eclampsia and intrauterine growth restriction (IUGR).Patients and methods A total of 1022 unselected women had color Doppler imaging of both uterine arteries at the time of their dating/anomaly scan (19-21 weeks' gestation). The presence or absence of notching of the flow velocity waveform (FVW) was noted, and the resistance index (RI) was measured. The main outcome measures were pre-eclampsia, birth weight, placental abruption and stillbirth. ResultsThe outcome in 946 women (92.6%) was available for analysis. Of these, 216 (23%) had abnormal uterine artery Doppler studies, 117 (12.4%) with bilateral (right and left FVW) notches; 21 (2.2%) women developed preeclampsia, and 57 (6.0%) neonates were small for gestational age (SGA; < 5th centile), at birth. For women with bilateral notches the odds ratio (OR) for developing pre-eclampsia was 12.8 (95% confidence interval (CI) 5.3-30.8), and 52.6 (95% CI 6.4-430.1) for pre-eclampsia requiring delivery before 37 weeks' gestation. If the uterine artery Doppler studies were normal, the odds ratio for developing pre-eclampsia was 0.11 (95% CI 0.04-0.28), and 0.3 (95% CI 0.17-0.51) for the delivery of an SGA baby less than the 5th centile. In women with bilateral notches with mean RI greater than 0.55, the positive predictive value for the main outcome measures was 46%.Conclusion Women with normal uterine artery color/ pulsed Doppler studies at 20 weeks' gestation constitute a group that have a low risk of developing obstetric complications related to uteroplacental insufficiency. Women with high resistance in both uterine arteries (bilateral notches) have an increased risk of the subsequent development of such complications, in particular those requiring delivery before term. The addition of color Doppler imaging of the uterine arteries at the time of the routine 20-week dating/anomaly scan may be of use in determining the type and level of antenatal care that is offered to women.

Doppler Triple-vessel Wave Pattern as a Screening Method for Prediction of Perinatal Outcome in Pregnancy-induced Hypertension

“…Of the 100 pregnant women in the study group, 54 (54%) were primigravida and 27 (27%) were gravida 2, which was similar to that quoted by Kurdi et al, 14 Martin et al, 15 and Papageorghiou et al 16 Out of 100 women in the study group, 41% women developed IUGR along with PIH and this was comparable to the study of Coleman et al 17 eclampsia is due to demographic variation of study population characteristics and their geographical variation as rural population have nutritional deficiency (above studies involved urban population) and due to biphasic screening method of the current study.…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Of the many risk markers for preeclampsia (Table 5) [99,111,, many are known at booking and increase the risk of preeclampsia two-to fourfold [165]. The strongest of these are previous preeclampsia, antiphospholipid antibody syndrome, pre-existing medical conditions, and multiple pregnancy (all bolded in Table 5).…”

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

“…xtensive research over the past 20 years has evaluated the use of uterine artery Doppler evaluation in the second [1][2][3][4][5][6] trimesters of pregnancy as a screening tool to predict the later development of preeclampsia, fetal growth restriction (FGR), placental abruption, and stillbirth. Since the introduction of uterine artery Doppler as an early screening test for complications in pregnancy in the mid-1980s, conflicting results on its value have been reported as discussed by Papageorghiou et al 4 The persistence of bilateral notches in uterine arteries associated with a quantitative resistance index cutoff at 24 weeks' gestation was reported to improve screening efficacy to identify patients at risk for complications in pregnancy.…”