title: Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes.
abstract: OBJECTIVE
  Our aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA).
  
  
  METHODS
  This retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A<0.3, hCG>3.0, AFP>2.5, inhibin>2.0, or unconjugated estriol<0.3MoM). At approximately 24weeks, we assessed UtA pulsatility index (PI).
  
  
  METHODS
  Preeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW<3%).
  
  
  RESULTS
  We identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI>1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)).
  
  
  CONCLUSIONS
  In patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9-15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.
authors.affiliation: UC San Diego Health System, Department of Reproductive Medicine, 200 W. Arbor Drive - MC 8433, San Diego, CA 92103, USA. Electronic address: haroeder@ucsd.edu.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
authors.affiliation: UCLA Medical Center, Department of Obstetrics and Gynecology, 757 Westwood Plaza, Room B711, Los Angeles, CA 90095, USA.
authors.forename: Sheila Z
authors.initials: SZ
authors.lastname: Dejbakhsh
authors.affiliation: UC San Diego Health System, Department of Pathology, Sanford Consortium for Regenerative Medicine, University of California San Diego, 9500 Gilman Drive, MC 0695, La Jolla, CA 92093-0695, USA.
authors.forename: Mana M
authors.initials: MM
authors.lastname: Parast
authors.affiliation: UC San Diego Health System, Department of Reproductive Medicine, 200 W. Arbor Drive - MC 8433, San Diego, CA 92103, USA.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Laurent
authors.affiliation: UC San Diego Health System, Department of Reproductive Medicine, 200 W. Arbor Drive - MC 8433, San Diego, CA 92103, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Woelkers
keywords: Abnormal analytes; Growth restriction; Preeclampsia; Preterm delivery; Risk stratification; Uterine artery Doppler