Doppler ultrasound can provide individualize risk of adverse pregnancy outcome


By Megan Rauscher

WESTPORT, CT (Reuters Health) – A woman's risk of having a severe adverse pregnancy outcome can be estimated by information garnered from uterine artery Doppler ultrasound screening performed at 23 weeks' gestation, according Dr. Christoph Lees of Rosie Maternity Hospital, Addenbrooke's NHS Trust, Cambridge and colleagues in the UK.

"We have known for nearly 20 years that abnormal uterine artery Doppler in the second trimester of pregnancy (14 to 26 weeks) is associated with preeclampsia and fetal growth restriction," Dr. Lees noted in comments to Reuters Health. "This was based on identifying high resistance uterine artery waveforms with 'notches'. What no one has been able to do before is to quantify the level of risk for an individual woman."

Dr. Lees and colleagues calculated the mean uterine artery pulsatility index (PI) and generated "likelihood ratios in relation to the PI" for severe adverse outcome in 5121 women who underwent Doppler examinations at 23 weeks' gestation as part of routine antenatal care.

A severe adverse outcome was defined as "fetal death, placental abruption, and delivery before 34 weeks associated with preeclampsia and birth weight less than the 10th centile," they explain in the September issue of Obstetrics and Gynecology.

They found that the likelihood of a woman having a severe adverse pregnancy outcome increased quadratically with mean uterine artery PI, independent of maternal age, ethnicity or parity. At a mean PI of 1.45, which was the 95th centile in the study population, the likelihood ratio for severe outcome is roughly 5 for nonsmokers and 10 for smokers, they report.

"This paper, based on over 5000 women, is novel in that it allows doctors to give a precise risk assessment for severe adverse outcome for each woman, enabling appropriate 'smart' or 'targeted' antenatal follow-up care or even prophylactic treatments to be used," Dr. Lees said.

Obstet Gynecol 2001;98:369-373.

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