Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation.
OBJECTIVE
To assess the screening properties of a mid-trimester uteroplacental Doppler scan in a normal unselected population.


METHODS
A cross-sectional study measuring an averaged resistance index (AVRI) from four sites (left and right uterine and arcuate arteries) with continuous wave Doppler ultrasound.


METHODS
Routine booking ultrasound, King's College Hospital, London.


METHODS
977 women at 16-24 weeks gestation.


METHODS
Intrauterine death, birthweight, pregnancy-induced hypertension (PIH), antepartum haemorrhage.


RESULTS
There was a 96.5% follow-up. Pregnancies with high AVRI values had a higher prevalence of proteinuric hypertension, placental abruption, small-for-gestational-age babies, and fetal loss. When AVRI was greater than 95th centile, the overall risk of pregnancy complications was 67%, and the risk of a severe complication was 25%. However, the sensitivity of the test for these complications was only 13% and 21% respectively. The risk for an individual woman with a high AVRI of developing a complication was increased by up to 9.8 times.


CONCLUSIONS
Although Doppler screening does detect a unifying defect leading to perinatal death, pre-eclampsia, growth retardation and placental abruption, the predictive values do not yet justify its introduction as a routine test.
Bewley
S
S
Department of Obstetrics and Gynecology, King's College Hospital Medical School, Denmark Hill, London.
Cooper
D
D
Campbell
S
S
D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D010920:Placenta / Q000098:blood supply* / Q000000981:diagnostic imaging; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012039:Regional Blood Flow; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging; D014655:Vascular Resistance