PREDICTIVE VALUE OF UTEROPLACENTAL AND FE TAL PERFUSION IN PREMATURE LABOR AS MEASURED BY DOPPLER ULTRASOUND

In a prospektive study, 114 pegnant women with premature labour were e xamined by Doppler ultrasound. The pulsatility indices (PI) of the ute rine arteries, the umbilical artery, the fetal descending thoracic aor ta and the middle cerebral artery were measured, both on admission and again after 2 weeks of tocolytic therapy (n = 59). An increased pulsa tility index in the uterine arteries correlated significantly with a d ecreased gestational age at birth, decreased ability to delay birth, d ecreased birth weight and decreased percentiles for gestational age. T here was also an increase in adverse fetal outcomes as shown by a feta l outcome score which included preterm birth, hypotrophy, fetal hypoxi a, fetal acidosis and impaired neonatal adaptation. Neither the PI val ues for the fetal vessels nor the combination of uterine and fetal per fusion showed any correlation with fetal outcome. Pathological PI valu es in the uterine and umbilical arteries cannot predict premature birt hs or other parameters of adverse fetal outcome with enough certainty as a sensitivity of max. 50% and a positive predictive value of max. 6 5 % show. A specificity of 70 - 95 % and a negative predictive value o f 51 - 96% indicate that in all probability a normal course can be exp ected for pregnancy and birth if the PI values are normal in threatene d premature labor. The combination of uterine and fetal perfusion valu es in a Doppler score does not improve the prognostic value. We conclu de that in premature labour, Doppler findings alone are not enough to make a reliable statement about the prognosis and therefore about the further management of the pregnancy. The multifactorial aetiology of p remature birth also points to a multifactorial assessment of prognosis .