Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre‐eclampsia and intrauterine growth retardation

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Abstract
Objective To evaluate the predictive value of transvaginal Doppler ultrasound studies of the uterine and umbilical arteries in early pregnancy, in identifying pregnant women at risk of subsequently developing pre‐eclampsia, or the delivery of a small for gestational age infant. Design A multivariate logistic regression of Z scores of Doppler indices obtained from the uterine and umbilical arteries of 652 women with singleton pregnancies at 12 to 16 weeks of gestation. Measurements included the presence or absence of a notch, bilateral (right and left waveform) notching, vessel diameter, the resistance index, the pulsatility index, time averaged mean velocity (cm/s), maximum systolic velocity (cm/s), and volume flow (mL/min). Stepwise logistic regression and multivariate analysis of all the parameters measured was used to construct several scoring systems. Main outcome measures Pre‐eclampsia, birthweight, preterm delivery. Results In women that developed complications, there was a trend towards increased resistance and reduced velocity and volume flow. If bilateral notches were present there was an increased risk of pre‐eclampsia (odds ratio [OR] 21.99, 95% CI 6.55–73.79), premature delivery (OR 2.38, 95% CI 1.19–4.75), and the delivery of a small for gestational age baby (OR 8.63, 95% CI 3.95–18.84). Using multivariate analysis, a seven parameter model was selected (after removal of vessel diameter, uterine and umbilical resistance index). This model produces a scoring system with a sensitivity of 92.9% and a specificity of 85.1% for the prediction of pre‐eclampsia. A three parameter model (bilateral notches, uterine resistance index, umbilical pulsatility index) provides similar sensitivities, but lower specificities, when compared with the seven parameter model. Conclusion These data indicate that there are differences in uterine and umbilical artery Doppler blood flow indices at 12 to 16 weeks, in pregnancies with a normal or complicated outcome. Scoring systems derived from multivariate analysis of Doppler indices demonstrate the potential of being able to identify, in early pregnancy, a group of women at increased risk of the subsequent development of pre‐eclampsia, premature delivery, or the birth of a small for gestational age baby.