Uterine artery Doppler: Changing Concepts in Prediction and Prevention of PE and FGR

Abstract

One of the most promising screening tools in detection of PE and FGR is uterine artery Doppler velocimetry. The underlying pathology for the development of PE is thought to be due to defective trophoblastic invasion of uterine spiral arteries. Increased impedance during mid-trimester is known to be associated with a high incidence of adverse pregnancy outcomes. High resistance in uterine arteries can be observed as early in the first trimester in cases with impaired placentation. The predictive efficacy of first trimester UtA Doppler has improved after the development of risk specific algorithm by including maternal characteristics, biophysical and biochemical parameters. With the understanding of late onset FGR and PE, it was realised that first trimester UtA Doppler may not serve as an efficient marker to identify this group which led to the evolution of its assessment in third trimester. The importance of UtA Doppler in third trimester is its ability to differentiate a physiologically small baby from a pathologically small fetus, which is growth restricted. PE and FGR remains an important cause of maternal and fetal mortality and its prediction is a challenging task which needs to be done early in gestation.Low dose aspirin when started before 16 weeks in the truly high risk population has proven to significantly reduce PE and FGR. To initiate aspirin therapy, the development of first trimester risk prediction model remains the key component. This paper is a review of the predictive efficacy of UtA Doppler in detecting uteroplacental insufficiency in each of the three trimesters.

Utilization of Uterine and Umbilical Artery Doppler in the Second and Third Trimesters to Predict Adverse Pregnancy Outcomes: A Nigerian Experience

“…Furthermore, in recent times, there has been reported late-onset fetal growth restriction and preecalmpsia that the first trimester uterine Doppler may not identify, hence the need for assessment in the third trimester. 23 In addition, scientific literature on Doppler studies shows that the uterine artery alone has been the major focus of attention in many studies evaluating the second or third trimester of pregnancy in predicting adverse pregnancy complications. 6–8 , 12 , 13 , 15 , 17 …”