Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis - PubMed (original) (raw)

Review

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Jeltsje S Cnossen et al. CMAJ. 2008.

Abstract

Background: Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters.

Methods: We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios.

Results: We identified 74 studies of pre-eclampsia (total 79,547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.

Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests.

PubMed Disclaimer

Figures

Box 1

Box 1

None

Figure 1: Identification of studies of uterine artery Doppler ultrasonography used to predict pre-eclampsia and intrauterine growth restriction, for inclusion in the meta-analysis. *Includes 6 studies on pre-eclampsia and 8 on intrauterine growth restriction that were added after manual search of bibliographies of selected articles.

None

Figure 2: Plots of receiver operating characteristics showing pooled and single accuracy estimates, with 95% confidence intervals, for uterine artery Doppler indices to predict pre-eclampsia and intrauterine growth restriction in the second trimester according to patient risk. Note: the x axis shows reversed specificity. The closer the index values are to the upper left corner of each graph, the greater the accuracy of that index. The test index that best predicted the development of pre-eclampsia (highest positive likelihood ratio) in low-and high-risk patients was an increased pulsatility index with notching. This index was also the best predictor of intrauterine growth restriction in low-risk patients. For intrauterine growth restriction in high-risk patients, the Doppler indices showed low predictive value. (The thresholds for the Doppler indices reported in the studies we reviewed are provided in Appendices 3 and 4 [available online at

www.cmaj.ca/cgi/content/full/178/6/701/DC2

].)

None

Figure 3: Plots of receiver operating characteristics showing pooled and single accuracy estimates, with 95% confidence intervals, for uterine artery Doppler indices to predict severe pre-eclampsia and severe intrauterine growth restriction in the first and second trimester. Note: the x axis shows reversed specificity. The closer the index values are to the upper left corner of each graph, the greater the accuracy of that index. In low-risk patients, an increased pulsatility index was the test characteristic that best predicted the development of severe pre-eclampsia or severe intrauterine growth restriction (highest positive likelihood ratio). In high-risk patients, the best predictor of each outcome was an increased resistance index > 0.58. (The thresholds for the Doppler indices reported in the studies we reviewed are provided in Appendices 3 and 4 [available online at

www.cmaj.ca/cgi/content/full/178/6/701/DC2

].)

Comment in

Similar articles

Cited by

References

    1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;365:785-99. - PubMed
    1. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74. - PubMed
    1. Montan S, Sjoberg NO, Svenningsen N. Hypertension in pregnancy — fetal and infant outcome: a cohort study. Clin Exp Hypertens — Part B Hypertens Pregnancy 1987;6:337-48.
    1. Rich-Edwards JW, Colditz GA, Stampfer MJ, et al. Birthweight and the risk for type 2 diabetes mellitus in adult women. Ann Intern Med 1999;130:278-84. - PubMed
    1. Barker DJ. The developmental origins of chronic adult disease. Acta Paediatr Suppl 2004;93:26-33. - PubMed

Publication types

MeSH terms

LinkOut - more resources