R. Becker, R. Vonk, W. Vollert, M. Entezami
Doppler sonography of uterine arteries at 20–23 weeks: risk assessment of adverse pregnancy outcome by quantification of impedance and notch
Objective: To assess the diagnostic value of Doppler
sonography of the uterine arteries (DSUA) at 20–23 gestational
weeks as screening procedure in a low risk population
Patients and methods: The study group consisted of
7508 singleton low-risk pregnancies. Doppler sonography
of both uterine arteries was performed as routine part of
anomaly scan. Impedance of both uterine arteries was
registered using the mean PI of the two uterine arteries. In
case of notch,“Notch-Index” was defined as (C-D)/C with
D = post-systolic nadir and C = following zenith of the
waveform. Outcome variables were placental abruption,
pre-eclampsia, intrauterine growth retardation, intrauterine/neonatal death and preterm delivery before 32 completed
gestational weeks. To discriminate normal and
pathological waveform, incidence of adverse pregnancy
outcome was related to four different definitions of
pathological waveform. To describe the severity of impairment
of perfusion, the frequency of adverse pregnancy
outcome was related to different classes of impedance.
Results: To find a simple discrimination between normal
and pathological uterine perfusion, best diagnostic
performance was reached by a definition using a combination
of high impedance and notch (no notch and
mean PI > P'95 or unilateral notch and mean PI > P'90
or bilateral notch and mean PI > P'50). The prevalence
of notch in nulliparae (8.5%) was higher than in parae
(4.7%) and decreased with increasing gestational age
(20 weeks: 8.6%–23 weeks: 5.4%). We found a clear relation
between elevation of impedance, depth of notch
and frequency of adverse pregnancy outcome with a
frequency of complications varying from 3.2% (mean
PI =?0.8, mean NI = 0.1) to 38.4% (mean PI > 2.0, mean
NI > 0.1
Conclusion: Doppler sonography of the uterine arteries
at 20–23 weeks has the capacity to predict at least a part
of severe forms of adverse pregnancy outcome and to assess
the probability of complications by quantification of
the impairment of the uterine blood
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 30, 09/2002
Pages: 388 - 394
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