Screening for placental insufficiency by transvaginal uterine artery Doppler at 22-24 weeks of gestation.
OBJECTIVE
To determine the value of routine transvaginal color Doppler assessment of the uterine arteries at 22-24 weeks of gestation in the prediction of placental insufficiency.


METHODS
Women with singleton pregnancies scheduled for routine ultrasound scans at 22-24 weeks were offered Doppler assessment of the uterine arteries by transvaginal ultrasound. The pulsatility index (PI) was obtained for each artery and the mean value was calculated. A mean PI >95th percentile was considered increased. Screening characteristics for predicting placental insufficiency, defined as preeclampsia, fetal growth restriction or intrauterine death, were calculated.


RESULTS
Doppler examination of the uterine arteries was carried out in 1,057 singleton pregnancies. The mean uterine artery PI was 1.03 and the 95th percentile was 1.55. In 54 cases (5.1%) the mean PI was >1.55 (screen-positive). In the study population there were 48 cases of preeclampsia (5.1%), 72 fetal growth restrictions (7.5%) and 7 intrauterine deaths (0.7%). The screen-positive group showed an incidence of 47.1% of combined adverse results. The relative risks after a positive screening test were 7.3 (CI 4.2-12.6) for pre-eclampsia, 3.9 (CI 2.3 - 6.6) for fetal growth restriction and 4.5 (CI 3.2-6.4) for overall placental insufficiency.


CONCLUSIONS
Uterine artery Doppler at 22-24 weeks identifies women at higher risk for the development of subsequent complications of placental insufficiency. This test could be used in combination with other markers to stratify the level of care offered in the third trimester of pregnancy.
Palma-Dias
Ricardo S
RS
Fetal Medicine Unit, Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. ricardo.palmadias@thewomens.org.au
Fonseca
Maria Mercedes C
MM
Brietzke
Elisa
E
Fritsch
Alessandra
A
Schlatter
Denise
D
Maurmann
Caroline B
CB
Stein
Nina R
NR
Magalhães
José Antônio A
JA
D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001158:Arteries / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods* / Q000592:standards*; D014599:Uterus / Q000098:blood supply*; D014621:Vagina; D055815:Young Adult