Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance.

OBJECTIVE

To assess the role of the placental arterial Doppler examination at 23-24 gestational weeks for predicting adverse perinatal outcome in high-risk pregnancies.

DESIGN

Retrospective register study.

SETTING

Skåne University Hospital in Malmö.

POPULATION: Six hundred and forty-five women with high-risk pregnancies, without fetal malformations or chromosomal abnormalities.

METHODS

Placental (uterine and umbilical artery) Doppler ultrasound examination at 23-24 gestational weeks.

MAIN OUTCOME MEASURES: Adverse perinatal outcomes including preeclampsia, small-for-gestational age newborns (smaller than 3rd percentile or smaller than the 10th percentile), preterm delivery (<34 weeks or <37 weeks of gestation at delivery), cesarean section, admission to the neonatal intensive care unit and intra-uterine fetal death.

RESULTS

Abnormal uterine artery Doppler values were detected in 45% of this high-risk group but abnormal umbilical artery Doppler indices were only seen in 3.7%. Adverse perinatal outcome increased significantly with increasing placental vascular impedance (p < 0.0001). There were seven cases of intrauterine fetal death and in five the uterine artery Doppler values at 23-24 weeks were abnormal. A strong correlation between abnormal uterine artery Doppler and preeclampsia was present, but not with other forms of hypertensive disorder.

CONCLUSION

Placental Doppler screening at 23-24 weeks can be used in detecting pregnancies at risk of adverse outcome and in selecting cases for more intense surveillance. A surveillance plan is proposed based on Doppler screening at 23-24 weeks of gestation.