Doppler ultrasound of the uteroplacental circulation in the prediction of pregnancy outcome in women with raised maternal serum alpha-fetoprotein.
OBJECTIVE
To determine whether Doppler waveforms from the uteroplacental circulation could improve the prediction of pregnancy outcome in women with raised maternal serum alpha-fetoprotein and a structurally normal fetus. The study further attempts to determine whether the presence of an early diastolic notch would constitute a better screening test than waveform patterns.


METHODS
An observational study.


METHODS
A tertiary referral obstetric service.


METHODS
All women referred to St George's Hospital with a raised maternal serum alpha-fetoprotein had waveform measurements from the uteroplacental circulation after exclusion of fetal abnormalities. Pregnancy outcome was determined by questionnaire sent to the referring clinicians.


METHODS
Adverse perinatal outcome in the form of preterm labour, low birthweight and perinatal mortality.


RESULTS
Data from 332 cases were available for analysis. Women with a normal pattern of uteroplacental waveforms had a perinatal mortality of 9.6/1000. Women with a uniform high resistance pattern had a perinatal mortality of 846/1000, and those with a mixed resistance pattern had a perinatal mortality of 268/1000. Overall there were 27 cases of placental abruption which accounted for eight of the 50 perinatal deaths. The remainder were due to prematurity or low birthweight or both. The presence of the early diastolic notch did not improve on the waveform patterns in the prediction of perinatal death.


CONCLUSIONS
Women with raised maternal serum alpha-fetoprotein and normal Doppler waveform patterns from the uteroplacental circulation can be reassured, but mixed or uniform high resistance patterns should encourage increased surveillance and a search for intervention therapies.
Robson
M
M
Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK.
Hamid
R
R
McParland
P
P
Pearce
J M
JM
D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000209:etiology; D010920:Placenta / Q000098:blood supply* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging; D014655:Vascular Resistance; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins