Role of Uterine Artery Doppler in Second Trimester in Predicting Adverse Pregnancy Outcome

Background: The study aimed at defining the role of Pregnancy associated plasma protein-A (PAPP-A) and uterine artery doppler (Ut.A.PI) in the development of adverse pregnancy outcome (APO) in high risk pregnancies.Methods: This was an observational study where 100 singleton pregnancies at high risk of development of APO, between 11 to 13 + 6 weeks POG were enrolled. PAPP-A levels were measured at 11 to 13 + 6 weeks POG and uterine artery doppler PI was measured at 20 weeks. Women were followed till delivery. Pregnancy outcome were seen and a cut off at which APO developed was derived.Results: In this study women with lower mean PAPP-A (0.75±0.19 MOM versus 1.23±0.31MOM) (p<0.001) values and higher Ut.A.PI (1.43±0.35MOM versus 0.99±0.25MOM) (p<0.001) developed APO. Cut off value for PAPP-A and Ut.A.PI was determined and was found to be ≤11.65 µg/ml (≤0.79MoM) and >1.42 (>1.19MoM) respectively which was higher than what is determined in other studies done on low risks populations thereby suggesting for an intervention or more meticulous observations at a higher cut offs.Conclusions: PAPP-A and uterine artery doppler are already being used for the screening of preeclampsia in most of the countries but not for other adverse pregnancy outcomes. PAPP-A levels along with the uterine artery PI in predicting APO in high risk women has high negative predictive value. Hence can be uses as a screening method in high risk population whether they should be used for low risk population also needs further evaluation.

Download Full-text

Uterine Artery Doppler in the Prediction of Preeclampsia and Adverse Pregnancy Outcome

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1134 ◽

2010 ◽

Vol 4 (2) ◽

pp. 117-122

Author(s):

George Daskalakis ◽

Aris Antsaklis

Keyword(s):

Pregnancy Outcome ◽

Uterine Artery ◽

Adverse Pregnancy Outcome ◽

False Positive Rate ◽

First Trimester ◽

Maternal Serum ◽

Uterine Artery Doppler ◽

Mortality And Morbidity ◽

Increased Risk ◽

Adverse Pregnancy

Abstract Preeclampsia and fetal growth restriction are major causes of perinatal mortality and morbidity. Several studies have shown that a generalized endothelial dysfunction is associated with these complications. Clinical trials have shown that pregnant women who demonstrate high resistance in uteroplacental blood flow are at higher risk for preeclampsia. Uterine artery Doppler studies both in the second and the first trimester can predict pregnancies at increased risk of the complications of impaired placentation. The sensitivity for predicting severe preeclampsia ranges between 80 and 90% for a false positive rate of 5 to 7%. Uterine artery Doppler screening at 20 to 24 weeks’ gestation is superior to first trimester screening, and appears to fulfill the requirements for a worthwhile screening test. Further research is needed to better assess the value of various combinations of uterine artery Doppler and maternal serum markers, for the prediction of adverse pregnancy outcome.

Download Full-text