Multicenter screening for pre‐eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation
Top Cited Papers
- 1 November 2001
- journal article
- research article
- Published by Wiley in Ultrasound in Obstetrics & Gynecology
- Vol. 18 (5), 441-449
- https://doi.org/10.1046/j.0960-7692.2001.00572.x
Abstract
To determine the value of transvaginal color Doppler assessment of the uterine arteries at 23 weeks of gestation in predicting the subsequent development of pre-eclampsia and fetal growth restriction. Women with singleton pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility index of the two arteries was calculated. Screening characteristics in the prediction of pre-eclampsia and the delivery of a low birth-weight infant were calculated. Doppler examination of the uterine arteries was attempted in 8335 consecutive singleton pregnancies, satisfactory waveforms were obtained from both vessels in 8202 (98.4%) cases and complete outcome data were available in 7851 (95.7%) of these. The mean gestational age was 23 (range, 22-24) weeks. The mean uterine artery pulsatility index did not change significantly with gestation (r = -0.0078; P = 0.483); the median value was 1.04 and the 95th centile was 1.63. In 9.3% of cases early diastolic notches in the waveform from both uterine arteries were present and in an additional 11.1% of cases there were notches unilaterally. Pre-eclampsia with fetal growth restriction occurred in 42 (0.5%) cases, pre-eclampsia without fetal growth restriction in 71 (0.9%) and fetal growth restriction without pre-eclampsia in 698 (8.9%). The sensitivity of increased pulsatility index above the 95th centile (1.63) for pre-eclampsia with fetal growth restriction was 69%, for pre-eclampsia without fetal growth restriction was 24%, for fetal growth restriction without pre-eclampsia was 13%, for pre-eclampsia irrespective of fetal growth restriction was 41% and for fetal growth restriction irrespective of pre-eclampsia was 16%. The sensitivity of fetal growth restriction defined by the 5th rather than the 10th centile was higher (19% vs. 16%). The sensitivity for both pre-eclampsia and fetal growth restriction was inversely related to the gestational age at delivery; when delivery occurred before 32 weeks, the sensitivity for all cases of pre-eclampsia with fetal growth restriction, pre-eclampsia without fetal growth restriction and fetal growth restriction without pre-eclampsia increased to 93%, 80% and 56%, respectively. The sensitivity of bilateral notches in predicting pre-eclampsia and/or fetal growth restriction was similar to that of increased pulsatility index but the screen-positive rate with notches (9.3%) was much higher than that with increased pulsatility index (5.1%). A one-stage color Doppler screening program at 23 weeks identifies most women who subsequently develop severe pre-eclampsia and/or fetal growth restriction.Keywords
This publication has 21 references indexed in Scilit:
- The effect of gestational age and placental location on the prediction of pre‐eclampsia by uterine artery Doppler velocimetry in low‐risk nulliparous womenUltrasound in Obstetrics & Gynecology, 2000
- The role of color Doppler imaging of the uterine arteries at 20 weeks' gestation in stratifying antenatal careUltrasound in Obstetrics & Gynecology, 1998
- Cervical length at 23 weeks of gestation: prediction of spontaneous preterm deliveryUltrasound in Obstetrics & Gynecology, 1998
- Doppler ultralsound of the uterine arteries: the importance of bilateral notching in the prediction of pre‐eclampsia, placental abruption or delivery of a small‐for‐gestational‐age babyUltrasound in Obstetrics & Gynecology, 1996
- Pregnancy Screening by Uterine Artery Doppler Velocimetry – Which Criterion Performs Best?Published by Ovid Technologies (Wolters Kluwer Health) ,1995
- Doppler velocimetry of the uterine artery as a screening test for gestational hypertensionUltrasound in Obstetrics & Gynecology, 1993
- Early doppler ultrasound screening in prediction of hypertensive disorders of pregnancyThe Lancet, 1990
- Review article: Doppler blood flow in pregnancyPlacenta, 1988
- NEW DOPPLER TECHNIQUE FOR ASSESSING UTEROPLACENTAL BLOOD FLOWThe Lancet, 1983
- The physiological response of the vessels of the placental bed to normal pregnancyThe Journal of Pathology and Bacteriology, 1967