Uteroplacental Doppler Flow Velocity Waveform Indices in Normal Pregnancy: A Statistical Exercise and the Development of Appropriate Reference Values

Abstract

In a prospective cross-sectional study, we examined 154 normal pregnant women and measured the systolic to diastolic (S/D) ratio and resistance index (RI) in the umbilical artery and both uterine arteries. Placental location with respect to laterality was determined by real-time ultrasound. In patients with unilateral placental location, each uterine artery was evaluated according to its relationship with the placenta. Doppler flow velocity waveforms were obtained by a continuous wave Doppler device. Kolmogorov D tests revealed that RI values follow gaussian distribution, but that S/D values were markedly skewed to the right. There was a significant negative linear relationship between gestational age and umbilical artery RI and a significant negative curvilinear relationship between gestational age and umbilical artery (S/D (r = 0.83, p less than 0.001; and r = -0.79, p less than 0.001, respectively). Confidence bands for umbilical artery RI were developed based on the linear model with gestational age (fitted umbilical artery RI = 0.97199 - 0.01045*gestational age). Confidence bands for umbilical artery S/D were derived from the corresponding RI values by means of the functional relationship S/D = 1/(1 - RI). The RI and S/D values of the uterine arteries declined until 24 to 25 weeks' gestation and remained unchanged thereafter. This relationship, however, was not statistically significant (r = -0.10, p = 0.22). The placental uterine artery is different from the nonplacental quantitatively and qualitatively.(ABSTRACT TRUNCATED AT 250 WORDS)

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