SCREENING PREGNANT-WOMEN AT 22-24 WEEKS FOR GESTATIONAL HYPERTENSION OR INTRAUTERINE GROWTH-RETARDATION BY DOPPLER ULTRASOUND FOLLOWED BY 24-HOUR BLOOD-PRESSURE RECORDING

Objective: To improve the efficacy of screening patients at increased risk of hypertension or intrauterine growth retardation, we combined t he assessment of increased uteroplacental resistance with a second-lin e screening using 24-h blood pressure monitoring. Methods: Doppler ass essment of uterine artery flow (resistance index, diastolic notch) at 20 and at 24 weeks gestation and 24-h ambulatory blood pressure were d etermined in 48 consecutive patients. Mean 24-h diastolic blood pressu re (M24-h DBP) was used as a measure to describe the overall pressure; regimen for each patient. Based on a cutoff of 68 mm Hg, the series wa s divided into two groups: 18 high-risk patients with abnormal M24-h D BP (higher than 68 mm Hg), and 30 low-risk patients (equal to or lower than 68 mm Hg). The results were blinded to clinicians. Main Outcome Measures: The development of gestational hypertension, preeclampsia, a nd intrauterine growth retardation (IUGR). Results: None of the 18 pat hological M24-h DBP as compared to 25/30 in the normal DBP group had a normal pregnancy outcome. The group with abnormal 24-h DBP monitoring delivered earlier and smaller infants than did the normal 24-h DBP gr oup. Sensitivity of combining these two methods to detect gestational hypertension was 79% and positive predictive value was 83%, whereas th e respective indices for IUGR were 90% and 50%. Conclusions: Screening patients with increased uteroplacental resistance with 23-h blood pre ssure recording improves the efficacy of the Doppler screening to iden tify patients at risk of an abnormal outcome of pregnancy.