title: Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial.
abstract: OBJECTIVE
  To ascertain whether screening for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) by uterine artery (UtA) Doppler in the second trimester of pregnancy and targeted surveillance improve maternal and perinatal outcomes in an unselected population.
  
  
  METHODS
  This was a multicenter randomized open-label controlled trial. At the routine second-trimester anomaly scan, women were assigned randomly to UtA Doppler or non-Doppler groups. Women with abnormal UtA Doppler were offered intensive surveillance at high-risk clinics of the participating centers with visits every 4 weeks that included measurement of maternal blood pressure, dipstick proteinuria, fetal growth and Doppler examination. The primary outcome was a composite score for perinatal complications, defined as the presence of any of the following: PE, IUGR, spontaneous labor < 37 weeks' gestation, placental abruption, stillbirth, gestational hypertension, admission to neonatal intensive care unit and neonatal complications. Secondary outcomes were a composite score for maternal complications (disseminated intravascular coagulation, maternal mortality, postpartum hemorrhage, pulmonary edema, pulmonary embolism, sepsis), and medical interventions (for example, corticosteroid administration and induction of labor) in patients developing placenta-related complications.
  
  
  RESULTS
  In total, 11 667 women were included in the study. Overall, PE occurred in 348 (3.0%) cases, early-onset PE in 48 (0.4%), IUGR in 722 (6.2%), early-onset IUGR in 93 (0.8%) and early-onset PE with IUGR in 32 (0.3%). UtA mean pulsatility index > 90(th) percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UtA Doppler vs non-Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had more medical interventions, such as corticosteroid administration (relative risk (RR), 1.79 (95% CI, 1.4-2.3)) and induction of labor for IUGR (RR, 1.36 (95% CI, 1.07-1.72)). In women developing PE or IUGR, there was a trend towards fewer maternal complications (RR, 0.46 (95% CI, 0.19-1.11)).
  
  
  CONCLUSIONS
  Routine second-trimester UtA Doppler ultrasound in an unselected population identifies approximately 60% of women at risk for placental complications; however, application of this screening test failed to improve short-term maternal and neonatal morbidity and mortality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: García
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.|Spanish Maternal and Child Health Network Retic (SAMID), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Llurba
authors.affiliation: Department of Obstetrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Valle
authors.affiliation: Spanish Maternal and Child Health Network Retic (SAMID), Instituto de Salud Carlos III, Madrid, Spain.|Department of Obstetrics, BCNnatal, Hospital Sant Joan de Dèu, Barcelona, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Gómez-Roig
authors.affiliation: Department of Obstetrics, Hospital Son Llatzer, Palma de Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Juan
authors.affiliation: Department of Obstetrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pérez-Matos
authors.affiliation: Spanish Maternal and Child Health Network Retic (SAMID), Instituto de Salud Carlos III, Madrid, Spain.|Department of Obstetrics, BCNnatal, Hospital Sant Joan de Dèu, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández
authors.affiliation: Department of Obstetrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: García-Hernández
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alijotas-Reig
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Higueras
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Calero
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Goya
authors.affiliation: Department of Statistics and Preventive Medicine, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.|Spanish Maternal and Child Health Network Retic (SAMID), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Carreras
authors.affiliation: Department of Obstetrics, Maternal-Foetal Medicine Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.|Spanish Maternal and Child Health Network Retic (SAMID), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Cabero
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011262:Pregnancy Trimester, Second; D012307:Risk Factors; D018608:Ultrasonography, Doppler / Q000379:methods*; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000502:physiology; D014655:Vascular Resistance
keywords: intrauterine growth restriction; perinatal outcome; pre-eclampsia; second trimester; uterine artery Doppler