Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.

Role of second trimester uterine artery doppler for the prediction of preeclampsia in high risk pregnancy

Background: The uterine artery Doppler has potentials for screening for complications of impaired placentation. The purpose of study was to assess the role of uterine artery color Doppler waveform analysis in second trimester for the prediction of preeclampsia in a high-risk pregnancy between 18-24 weeks of gestation.Methods: 100 women with moderate or high-risk factors for developing preeclampsia reporting to Obstetrics and Gynaecology department of Government Medical College and Hospital, Sector 32, Chandigarh were enrolled for present study. Transabdominal uterine artery doppler measurements was done at 18-24weeks of gestation in these patients. Doppler . The Doppler indices generated automatically from the machine , the Pulsatility Index (PI), Resistance Index (RI) , presence or absence of diastolic notch and S/D Ratio were recorded, and average was calculated.Results: Out of 100 patients there were 46 primigravidas with no additional risk factors, 22 pateints with two or more risk factors and there were no patients who had three or more risk factors in present study population. Preeclampsia is seen more commonly in primigravida and primigravida is considered as moderate risk factor for preeclampsia. It was found that an elevated second trimester uterine artery RI was significantly associated with developing preeclampsia later in pregnancy. The sensitivity and specificity of uterine artery Doppler velocimetry were found to be 84% and 55% respectively. Receiver operator characteristics (ROC) curves were created to demonstrate the prognostic value of RI and PI of uterine artery doppler indices at 18-24 weeks of gestation for the development preeclampsia. In addition, there were statistically significant positive correlations between mean RI of uterine artery doppler study and patients who developed preeclampsia. With a sensitivity of 84.21% it could identify 31% of the cases of preeclampsia at a false positive rate of 44.4%.Conclusions: Uterine artery doppler study can be used as a predictor of moderate strength for preeclampsia.

Clinical significance of Doppler velocimetry and oligohydramnios in intrauterine growth restriction / 대한산부인과학회지

OBJECTIVE: The aim of this study is to prove the clinical significance by evaluating pregnancy outcomes from intrauterine growth restriction using waves of the Doppler velocimetry of uterine and umbilical artery and amniotic fluid index. METHODS: Throughout the period of January 2000 to May 2005 at our hospital, we reviewed 127 cases diagnosed with intrauterine growth restriction after 24 weeks of pregnancy and the existences of diastolic notch of uterine artery (DNUT), absent or reversed end-diastolic velocity of umbilical artery (AEDV) and oligohydramnios were considered abnormal. We set the group that had no abnormal signs as the control group (62 cases), and respectively compared the groups that had oligohydramnios (24 cases), unilateral DNUT (27 cases), bilateral DNUT (10 cases) and AEDV (13 cases) with the control group. And we compared the groups that had only one abnormal sign, that is oligohydramnios (20 cases), bilateral DNUT (7 cases), AEDV (7 cases) and the group showing 2 or more complicated abnormal signs those above (9 cases) with the control group. RESULTS: Perinatal outcomes such as preterm birth, low birth weight, lower 5-min Apgar score (A/S), neonatal acidosis, admission rate of neonatal intensive care unit (NICU) and perinatal mortality were poor statistically in groups with DNUT, AEDV and oligohydramnios compared to those which have none of these abnormal signs. And those with DNUT had worse results when affected on both sides. And those with AEDV showed worse perinatal outcomes compared to those with bilateral DNUT or oligohydramnios; any overlapping of these abnormal signs indicated worse perinatal outcomes, which had statistic significance. CONCLUSION: Close observation of the fetal well-being by analysis on the wave velocimetry of the blood flow such as the uterine arteries and umbilical arteries and the measurement of the amniotic fluid volume enables predicting the perinatal prognosis of the intrauterine-growth restricted fetuses which may contribute in reducing the perinatal morbidity and mortality.

The Prediction of Pre-eclampsia/Fetal Growth Restriction based on Notch of Uterine Artery Doppler Velocimetry / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to evaluate the predictability of pre-eclampsia and fetal growth restriction(FGR) using the notch of uterine artery Doppler velocimetry after the second trimester of pregnancy, and to evaluate the hemodynamic changes preceeding the onset of symptoms of pre-eclampsia, therefore determining the significance of the notch in uterine artery Doppler velocimetry. MATERIALS AND METHODS: Between March 1996 and April 1999, in Severance Hospital, 99 pregnant women who showed notches in uterine artery Doppler velocimetry at the 24th to 32nd gestational weeks were studied. Those already manifested by pre-eclampsia and FGR were excluded. The study population were divided into two groups, women in their 24-26th gestational weeks and in their 27-32nd gestational weeks, and the prevalence of pre-eclampsia and FGR were evaluated in each group. Also, the prevalence of the mentioned diseases according to the bilaterality of the notch, and the duration to the onset of the symptoms of pre-eclampsia were compared. RESULTS: Among 42 patients who showed the notch in the 24-26th gestational weeks, 14 developed pre-eclampsia/FGR(33.3%), and among 57 in the 27-32nd gestational weeks, 17 developed the mentioned diseases(31.5%). No significant difference in prevalence rate was observed. In those who showed bilateral notches, 11 out of 24 cases developed pre-eclampsia/FGR(45.8%). In those with unilateral notch, 20 out of 75 cases had the disease(26.7%). The difference in the two groups were statistically significant(p<0.05). Among 42 patients who showed the notch in the 24-26th gestational weeks, 7 developed pre-eclampsia(16.7%), and among 57 in the 27-32nd gestational weeks, 17 developed pre-eclampsia(15.7%). No significant statistic difference was observed. The duration to the onset of symtoms of pre-eclampsia were 5.3 and 5.5 weeks each group. CONCLUSIONS: The notch means early marker of hemodynamic changes preceeding the onset of symptoms of pre-eclampsia. Therefore, patients who show the notch of uterine artery Doppler velocimetry in the second half of pregnancy should be considered as high risk patients for either pre-eclampsia or FGR, and especially those with bilateral notches require close observation and follow-up.

Clinical significance of early diastolic notch of uterine artery Doppler velocimetry in relation to placental location / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.

A New Marker as Perinatal Predictor: Notch Index of Uterine Artery Doppler Velocimetry / 대한산부인과학회잡지

Uterine Artery Doppler velocimetry is widely applied to predict pregnancy outcomes.Recent studies of uterine artery early diastolic notch demonstrate that it is good marker forfetal well-being. The early diastolic notch represents the reflected wave of uteroplacentalcirculation. The degree of back flow is reflected by the depth of the notch. The authorspropose a new Doppler parameter, notch index(early diastolic velocity/maximum diastolicvelocity) which is a better indicator of adverse perinatal outcomes than the isolated findingof an early diastolic notch. Its ability to predict adverse perinatal outcomes was evaluatedin 121 pregnant women beyond the 28th weeks of gestation showing early diastolic notch.The incidence of adverse perinatal outcome(five minute Apgar score<7, cesarean sectiondue to fetal distress, admission to neonatal intensive care unit, or perinatal death) was 100% when the notch index was below 0.7. When the notch index range was 0.7~0.8, 0.8~0.9and greater than 0.9, the incidence of adverse perinatal outcome was 72.4%, 46.6%, and 25%, respectively. This study suggests that notch index could be used as new a marker topredict adverse perinatal outcome.

Is Doppler Velocimetry Useful for the Prediction of Uteroplacental Insufficiency? / 대한산부인과학회잡지

This study was designed to investigate a possible role for Doppler velocimetry as apredictor of uteroplacental insufficiency with fetal heart rate(FHR) tracing. From January1994 to through May 1996, we studied 419 high risk pregnant women who underwent Dopplervelocimetry within 1 week of intrapartum cardiotocogram or contraction stress test(CST) after 30 gestational weeks. The presence of a diastolic notch in uterine artery,elevated systolic/diastolic(S/D) ratios in umbilical artery(more than 3.0), or in uterine artery(more than 2.6) were considered abnormal. All of the 419 subjects were performed intrapartumcardiotocogram or CST within 1 week after Doppler veocimetry. Seventeen caseswere associated with persistent late deceleration or positive CST. The sensitivity, specificity,positive predictive value, negative predictive value, and relative risk of umbilical arteryS/D ratio for predicting abnormal FHR tracing were 23.5%(4/17), 89.3%(359/402), 8.5%(4/47), 96.5%(359/372), and 0.97. those of uterine artery S/D ratio and diastolic notch were29.4%(5/17), 92.5%(372/402), 14.3%(5/35), 96.9%(372/384), 1.35 and 35.3%(6/17), 90.3%(363/402), 13.3%(6/45), 97.6%(363/374), 3.88 respectively. The presence of uterine arterydiastolic notch in Doppler velocimetry seems to be a better predictor for abnormal FHRtracing after 30 weeks gestation than are S/D ratios in umbilical or uterine arteries.In conclusion, we can suggest that the presence of diastolic notch in uterine arteryDoppler velocimetry might be useful to predict the uteroplacental insufficiency after 30gestational weeks.