THE CLINICAL IMPLICATIONS OF EARLY DIASTOLIC NOTCH IN 3RD-TRIMESTER DOPPLER WAVE-FORM ANALYSIS OF THE UTERINE ARTERY

To evaluate the clinical utility of third trimester Doppler waveform a nalysis of the uterine artery in predicting complicated pregnancies an d fetal well-being, we compared adverse pregnancy outcomes in 2321 wom en with the presence of an elevated systolic-diastolic ratio (greater than 2.6) with the persistence of an early diastolic notch and with th e combination of an elevated systolic-diastolic ratio and an early dia stolic notch. The positive predictive values are 47.5%, 82.9%, and 92. 6%, respectively. From these data we can conclude that determination o f the presence or absence of an early diastolic notch is more valuable in predicting the perinatal outcome than is the presence of an elevat ed systolic-diastolic ratio alone. We also suggest that an assessment of the uterine artery systolic-diastolic ratio combined with the evalu ation for persistent early diastolic notch would be a clinically usefu l test for fetal well-being.