Predictive Value of Uterine Artery Velocimetry at Midgestation in Low- and High-Risk Populations: A New Perspective

Abstract

Objective: The aim of this study was to assess the value of uterine artery Doppler velocimetry performed at 18–20 and 22–24 weeks of gestation in predicting preeclampsia and adverse pregnancy outcome in low- and high-risk patients. Methods: 865 pregnant women were evaluated: 335 and 530 pregnant women represented the high- and low-risk groups, respectively. Doppler ultrasound examination of the uterine arteries was performed at 18–20 weeks of gestation in 385 patients and at 22–24 weeks of gestation in 659 patients. Pregnancy outcome was evaluated in terms of: onset of preeclampsia; birth weight <2,500 g; birth weight <1,750 g; delivery before 36 weeks, and delivery before 32 weeks. Results: At 18–20 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 94% in low- and high-risk groups, respectively. Excellent negative predictive values towards birth weight <1,750 g (97% in low-risk and 93% in high-risk groups) and delivery prior to 32 weeks of gestation (99% in low-risk and 95% in high-risk groups) were obtained. At 22–24 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 97% in low- and high-risk groups, respectively. Negative predictive values towards birth weight <1,750 g were 97% in low-risk and 94% in high-risk groups, whereas towards delivery prior to 32 weeks of gestation they were 98% in low-risk and 94% in high-risk groups. Conclusion: Doppler evaluation of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and can also be used in prenatal surveillance of a low-risk population.

World Health Organization Systematic Review of Screening Tests for Preeclampsia

“…Twenty-two provided data on low-risk obstetric populations (n ϭ 40,039), 22-36,39 -43,45-47 18 reported data on high-risk patients (n ϭ 2,222), 48 -61,63-66 and 3 reported data on both low-and high-risk obstetric populations. 37,38,44,62 Description and methodologic quality are summarized in Tables 2 and 3. Of the 22 studies evaluating low-risk obstetric populations, only 5 (23%) fulfilled all 5 methodologic criteria, 25,27,32,35,43 and 8 (36%) met 4 of them.…”

“…Twenty-four studies were available for the pooled analysis, 8 each for a resistance index greater than 0.58 or greater than the 90 -95th percentile, [22][23][24]26,28,32,37,42 the presence of any diastolic notch, 25,33,34,36,38,40,41,47 and the presence of bilateral diastolic notches. 30,33,35,36,39,41,46,47 The use of a resistance index greater than 0.58 or greater than the 90 -95th percentile for predicting preeclampsia produced heterogeneous estimates of likelihood ratios of 4.2 (95% CI 3.6 -5.1) and 0.6 (95% CI 0.5-0.7) for a positive result and negative result, respectively (I 2 heterogeneity test ϭ 62%).…”

Ultrastructural study on human placenta from intrauterine growth retardation cases

“…Color Doppler ultrasound is helpful in determining the growth potential of fetuses in the case of placental dysfunction, measuring placenta/fetus blood flow. (Caforio et al, 1999;Guiot et al, 2003).…”

Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction

“…Hence, the increased resistances in the placental vascular bed due to impaired placentation refl ecting indirectly either in the uterine artery Doppler as macroscopic state or in the tHcy level as microscopic state may be combined in the screening of low-risk populations. The usefulness of midtrimester uterine artery Doppler as being most investigated and a promising screening tool has been confi rmed in high-risk populations; however, the predictive value in low-risk populations is limited [21,22] .…”