One-Stage Screening for Pregnancy Complications by Color... : Obstetrics & Gynecology (original) (raw)

ORIGINAL RESEARCH

One-Stage Screening for Pregnancy Complications by Color Doppler Assessment of the Uterine Arteries at 23 Weeks' Gestation

ALBAIGES, GERARD MD; MISSFELDER-LOBOS, HANNAH MD; LEES, CHRISTOPH MD; PARRA, MAURO MD; NICOLAIDES, KYPROS H. MD

Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.

Address reprint requests to: Christoph Lees, MD, Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom; E-mail: [email protected]

The study was supported by The Fetal Medicine Foundation (Charity number 1037116).

The authors thank Paul Seed, Division of Primary Care and Health Sciences, Guy's, King's and St. Thomas's Hospitals, for valuable statistical input.

Received September 27, 1999. Received in revised form April 17, 2000. Accepted May 11, 2000.

Objective

To estimate the value of screening for preeclampsia and fetal growth restriction by performing color Doppler assessment of uterine arteries at 23 weeks' gestation in predicting adverse pregnancy outcome.

Methods

Women with singleton pregnancies who attended routine ultrasonography at 23 weeks had color Doppler uterine artery imaging. Bilateral uterine artery notches were noted and left and right uterine artery pulsatility indices (PI) were measured. A mean PI of more than 1.45 was considered increased. Screening characteristics for predicting preeclampsia and delivery of small-for-gestational-age infants were calculated.

Results

Of 1757 pregnancies, increased PI was present in 89 (5.1%) and bilateral notches were noted in 77 (4.4%). Twenty-three of 65 women (35.3%; 95% confidence interval [CI] 23.9, 48.2) had increased PI and later developed preeclampsia, and 8 of 10 (80%; 95% CI 44.4, 97.5) with preeclampsia required delivery before 34 weeks. The respective values for women with bilateral notches were 21 of 65 (32.3%; 95% CI 21.2, 45.1) and 8 of 10 (80%; 95% CI 44.4, 97.5). The sensitivity of increased PI was 30 of 143 (21%; 95% CI 14.6, 28.6) for delivery of an infant with birth weight below the tenth percentile and 7 of 10 (70% 95% CI 34.8,93.3) for birth weight below the tenth percentile delivered before 34 weeks. The respective values for bilateral notches were 19 of 143 (13.3%; 95% CI 8.2, 20) and 5 of 10 (50%; 95% CI 18.7, 81.3).

Conclusion

A one-stage color Doppler screening program at 23 weeks identified most women who subsequently developed serious complications of impaired placentation associated with delivery before 34 weeks. The screening results were similar when the high-risk group was defined as women with increased PI or bilateral notches.