The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population.

AIM: The aim of this prospective study was to assess the role of uterine artery color Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters in risk pregnancies (n=52).

METHODS: Various uterine artery Doppler ultrasound parameters (resistance index (RI)>0.58, RI>0.7 and uni/bilateral or bilateral notching) were tested. The mean time of delivery was 37+1 weeks' gestation. Six newborns (12%) were delivered before 34 weeks of gestation. The mean birth weight was 2,910 g. Dystrophic fetuses (<10% percentile) were registered in 7 cases (13%). In 11 of the 52 women (21%) a cesarean section was performed because of abnormal fetal heart recording.

RESULTS: Preeclampsia was diagnosed in 4 cases (8%). In 4 cases (8%) an intrauterine fetal death was diagnosed. Placental abruption did not occur. The sensitivity of notching for the prediction of preeclampsia and for the prediction of a severe pregnancy complication was 75 and 69% with relative risks of 2.7 and 2.0. The sensitivity of notching in the uterine arteries for developing an intrauterine growth retardation (IUGR) was 71% with a relative risk of 2.2. The sensitivity of RI>0.58 in the uterine arteries for developing an IUGR was 67% with a relative risk of 5.4. The sensitivity of RI>0.58 for the prediction of preeclampsia, of intrauterine death and for the prediction of a severe pregnancy complication was 50, 75 and 80% with relative risks of 2.7, 8.1 and 10.9 respectively.

CONCLUSION: The results of this study suggest that Doppler ultrasound of the uterine artery in the second trimester of gestation is a useful method to predict abnormal outcomes in risk pregnancies, with high negative predictive values.