The Value of Doppler Study of the Umbilical Artery in Predicting Perinatal Outcome in Pre‐Eclamptic Patients

Rocca, M.; Said, Mohamed S.; Khamis, Mohamed Moataz; Ghanem, Ibrahim Abdel Latif; Karkour, Tarek

doi:10.1111/j.1447-0756.1995.tb01032.x

Cited by 3 publications

(5 citation statements)

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“…The initial umbilical artery PI had good sensitivity for poor outcome and major morbidity (75 and 58% respectively) in line with other publications reporting more adverse outcome in pre-eclampsia when umbilical artery waveforms are abnormal. [11][12][13]18,19 The current results, however, are in contrast to 18 Yoon (1994), who showed the umbilical artery waveform to be an independent predictor of poor outcome with an odds ratio of 14.2 after correcting for GA. The much narrower definition of adverse outcome in the current, larger cohort, may account for the lower relative risk as well as the lack of statistical significance in multivariate analysis including the fetal weight estimation.…”

Section: Placental Insufficiencycontrasting

confidence: 98%

“…2,5,6 The coexistence, temporal changes and prognostic implications of abnormal ultrasound and Doppler findings are now well described in placental insufficiency, [7][8][9] but while knowledge of umbilical artery Doppler results 10 is of clear clinical benefit, the use of other ultrasound and Doppler parameters has not yet been shown to improve perinatal outcome. In preterm pre-eclampsia, some studies have investigated the prognostic value of such parameters close to delivery, [11][12][13][14][15][16][17] but combinations of parameters, their inter-relations and the influence of confounding variables in this setting have not been investigated widely. [18][19][20] Before one can assume that assessment of fetoplacental blood flow patterns should affect the management of preterm pre-eclampsia, it needs to be established which findings contribute independently to the ultimate prognosis, either at the time of diagnosis or during serial reassessment.…”

Section: Introductionmentioning

confidence: 99%

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Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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Section: Placental Insufficiencycontrasting

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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“…The PPV for FGR reported in the individual studies were between 77.40 and 88.5,11 16 21 24 while the area under the receiver operating characteristic (AU ROC) curve was 0.63,17 mostly in high-risk pregnancies. The NPV ranged from 55.4 to 95.65 11 16 21 24. FGR was defined as birth weight or abdominal circumference below the 10th percentile in two studies,11 17 ponderal index less than 10 in one study,21 and was not defined in the remaining studies 16 24 26.…”

Section: Resultsmentioning

confidence: 97%

“…Twenty studies evaluated the UA,10–29 and seven reported its predictive values for FGR. The PPV for FGR reported in the individual studies were between 77.40 and 88.5,11 16 21 24 while the area under the receiver operating characteristic (AU ROC) curve was 0.63,17 mostly in high-risk pregnancies. The NPV ranged from 55.4 to 95.65 11 16 21 24.…”

Section: Resultsmentioning

confidence: 99%

“…The NPV ranged from 55.4 to 95.65 11 16 21 24. FGR was defined as birth weight or abdominal circumference below the 10th percentile in two studies,11 17 ponderal index less than 10 in one study,21 and was not defined in the remaining studies 16 24 26. Increased flow impedance in the UA had PPV for composite adverse outcomes between 66.60 and 96.6 in high-risk pregnancies 11 13 19 23.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

et al. 2021

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ObjectivesThis systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC).DesignWe searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020.SettingObservational or interventional studies from LMICs.ParticipantsSingleton pregnancies of any risk profile.InterventionsUmbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava.Primary and secondary outcome measuresPerinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO).ResultsWe identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations.ConclusionLocal evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative.PROSPERO registration numberCRD42019128546

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Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

Heazell

Hayes

Whitworth

et al. 2019

Cochrane Database of Systematic Reviews

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The Value of Doppler Study of the Umbilical Artery in Predicting Perinatal Outcome in Pre‐Eclamptic Patients

Abstract: The abnormal Doppler result usually precedes the appearance of abnormal BPP. The abnormal Doppler result helps to identify the fetus at risk that needs further surveillance.

Cited by 3 publications

References 11 publications

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

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