Performance of Doppler ultrasonography as a screening test in low risk pregnancies: results of a multicentric study.

Abstract

To assess the efficacy of the Doppler velocimetry of the uterine and umbilical arteries as a screening test for preeclampsia and fetal growth retardation, we studied 916low risk pregnancies. The SI D ratios of the uterine and umbilical arteries were obtained at 19 to 24 weeks and at 26 to 31 weeks of gestational age. Mean values, receiver operator curves, and the diagnostic accuracy of the tests were calculated for the following end-points: (1) pregnancy-induced hypertension, (2) low birth weight for gestational age, (3) small for gestational age with abnormal outcome, (4) pregnancy-induced hypertension needing preterm delivery. The prevalences for these out-ABBREVIATIONS S/0, Systolic-diastolic; PIH, Pregnancy-induced hypertension; SGA, Small for gestational age; IUGR, Intrauterine growth retardation Received November 19, 1993, from lstituto di Ginecologica e Ostetrica, Universita di Torino {T.T., S.B., M.B.); Clinica Ostetrica e Ginecologica, lstituto di Scienze Biomediche, Ospedale S. Paolo, Universita di Milano (E.F., B.B.); Clinica Ostetrica e Ginecologica, Universila Tor Vergata, Roma {G.R., H.V.); Clinica Ostetrica e Ginecologica, Cattedra di FJSiopatologica Prenatale, Universila di Bologna (S.g., G.L.P.); Clinica Ostetrica e Ginecologica, Universita di Siena (F.MS.); and Clinica Ostetrica e Ginecologica, Universita di Ancona {D.A., V.B.), Italy. Revised manuscript accepted for publication January 25, 1995.Address correspondence and reprint requests to Prof. Tull'ia Todros, lstituto dl Ginecologica e Ostetrica, Via Ventimiglia 3, 10126 Torino, Italy.This work was supported by the National Research Council (CNR)-Targeted Project "Prevention and Control Di, ease Factors," Subproject SP7 n.9100093PF41. comes were 3.4%, 4.6%, 1%, and 0.7%, respectively. The study was blinded. The umbilical and uterine artery SID ratios were significantly higher in the abnormal than in the normal outcome group. When uterine arteries were studied at 19 to 24 weeks, sensitivity was 59% in the detection of pregnancy-in· duced hypertension, 11% in the detection of small for gestational age fetuses, 33% in the detection of small for gestational age fetuses with abnormal outcome, and 83% in the detection of pregnancy-induced hypertension needing preterm delivery; the corresponding values for specificity were 69%, 94%, 94%, and 68%. At 26 to 31 weeks the sensitivity val· ues were respectively, 69%, 58%, 75%, and 100% and specificity values were 80%, 59%, 39%, and 79%. When umbilical arteries were studied at 19 to 24 weeks, sensitivity was 38% in the detection of pregnancy-induced hypertension, 46% in the detection of small for gestational age fetuses, 78% in the detection of small for gestational age fetuses with abnormal outcome, and 67% in the detection of pregnancy-induced hypertension needing preterm delivery. The corresponding values of specificity were 74% for all four groups. At 26 to 31 weeks the sensitivity values were 38%, 43%, 87%, and 67%, respectively, and specificity values were 80% for all four groups. We conclude that...

Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia

“…For a long time, the detection of abnormal uterine artery Doppler waveform (elevated resistance index and notching) during the second trimester of pregnancy was considered as a good tool for the screening of high-risk pregnancies, although it shows a low positive predictive value. [32][33][34][35] Previous reports highlighted how TVR and CO can improve the uteroplacental screening test. 20 In our previous studies, cardiac functional and structural alterations were present in normotensive pregnant women before the earlyonset preeclampsia, and in gestational hypertension before the appearance of subsequent complications.…”

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

“…Uterine Doppler waveforms analysis has become a valuable tool in the evaluation of the placental circulation and in the prediction of pregnancy outcome. Increased placental vascular impedance is frequently related to FGR and pregnancy-induced hypertension, 1,3,6,[7][8][9][10][11][12] which are still unsolved severe clinical problems associated with an increased maternal and perinatal mortality and morbidity. Maternal uterine artery Doppler in the second trimester of pregnancy helps the obstetricians to select patients at high risk for these complications but with a too low positive predictive value.…”

Screening for Intrauterine Growth Restriction

“…17 However, in these studies the number of patients examined was relatively small and methodology and definitions varied widely. [18][19][20][21][22][23][24][25] In 2001 a multicenter study of 8000 unselected women, the largest of its kind, was published by Papageorghiou et al showing that a one-stage color Doppler screening program at 23 weeks gestation identifies most women who subsequently develop severe IUGR requiring delivery before 34 weeks. 26 Therefore in singleton pregnancies there is now extensive literature in both high-risk and unselected populations, which suggest that uterine artery velocimetry can predict the development of subsequent IUGR with a sensitivity of around 30% for a 5% screen-positive rate.…”