A prospective analysis of the role of uterine artery Doppler waveform notching in the assessment of at-risk pregnancies.
OBJECTIVE
To determine the value of second trimester uterine artery Doppler waveform notching in the prediction of adverse pregnancy outcome in a high-risk group.


METHODS
Analysis of data from a consecutively collected cohort.


METHODS
St. James University Hospital, Leeds, UK.


METHODS
Three hundred thirty women known to be at risk of preeclampsia (PET) or intrauterine growth restriction (IUGR) were assessed for notching of the uterine artery Doppler waveform between 24-30 weeks of pregnancy.


METHODS
Preeclampsia (PET), small-for-gestational-age at birth (SGA), preterm delivery (PTD), perinatal death.


RESULTS
Two hundred thirty-two women (70.3%) had a normal uterine artery Doppler waveforms, and 98 (29.7%) demonstrated either unilateral or bilateral notching. In women where notching was present, 20 (20%) developed PET compared with 8 (3.5%) in the normal group [Odds ratio (OR) 7.2, CI 3-17]; SGA birthweight was present in 24 (24.5%) of the notched group and in 21 (9%) of normal group (OR 3.3; CI 1.7-6.2); 40 (41%) of the notched group delivered preterm ( < 37 weeks) as compared with 37 (16%) of the normal group (OR 7.9; CI 4.6-13). This difference was even more marked when delivery before 32 weeks was considered, occurring in 8 (8%) of the notched group and 4 (1.7%) of the normal group (OR 11.5; CI 4.5-29.4). Of the six perinatal deaths, five (5.1%) occurred in the notched group (OR 12.4; CI 1.4-108).


CONCLUSIONS
This study demonstrates that the addition of uterine Doppler waveform analysis to the monitoring profile of women at risk of PET, SGA, IUD and preterm delivery can further define those in a higher risk group and the majority that have a risk no higher than the background.
El-Hamedi
Afaf
A
University Department of Obstetrics and Gynaecology, St. James University Hospital, Leeds, UK.
Shillito
Jayne
J
Simpson
Nigel A B
NA
Walker
James J
JJ
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D006801:Humans; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D047928:Premature Birth; D011446:Prospective Studies; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging*