DOPPLER ULTRASOUND OF THE UTEROPLACENTAL CIRCULATION IN THE PREDICTION OF PREGNANCY OUTCOME IN WOMEN WITH RAISED MATERNAL SERUM ALPHA-FETOPROTEIN

Objective To determine whether Doppler waveforms from the uteroplacent al circulation could improve the prediction of pregnancy outcome in wo men with raised maternal serum alpha-fetoprotein and a structurally no rmal fetus. The study further attempts to determine whether the presen ce of an early diastolic notch would constitute a better screening tes t than waveform patterns. Design An observational study. Setting A ter tiary referral obstetric service. Subjects All women referred to St Ge orge's Hospital with a raised maternal serum alpha-fetoprotein had wav eform measurements from the uteroplacental circulation after exclusion of fetal abnormalities. Pregnancy outcome was determined by questionn aire sent to the referring clinicians. Main outcome measures Adverse p erinatal outcome in the form of preterm labour, low birthweight and pe rinatal mortality. Results Data from 332 cases were available for anal ysis. Women with a normal pattern of uteroplacental waveforms had a pe rinatal mortality of 9.6/1000. Women with a uniform high resistance pa ttern had a perinatal mortality of 846/1000, and those with a mixed re sistance pattern had a perinatal mortality of 268/1000. Overall there were 27 cases of placental abruption which accounted for eight of the 50 perinatal deaths. The remainder were due to prematurity or low birt hweight or both. The presence of the early diastolic notch did not imp rove on the waveform patterns in the prediction of perinatal death. Co nclusion Women with raised maternal serum alpha-fetoprotein and normal Doppler waveform patterns from the uteroplacental circulation can be reassured, but mixed or uniform high resistance patterns should encour age increased surveillance and a search for intervention therapies.