Uterine artery Doppler velocimetry in the prediction of adverse obstetric outcomes in unexplained MSAFP elevations

Unexplained maternal serum-fetoprotein (MSAFP) elevation has been known to be associated with adverse obstetric outcomes, however it is not sufficient ly useful as a screening test. This study was undertaken to determine wheth er uterine artery Doppler velocimetry could define a subset of patients wit h an elevated MSAFP level in whom complications of pregnancy might develop. The subjects included 179 women between 26 and 28 weeks' gestation with MS AFP greater than or equal to 2.5 multiples of the median, in whom either th e presence of an early diastolic notch or a resistance index 0.6 was consid ered as an abnormal Doppler velocimetry finding. Those subjects who display ed abnormal Doppler velocimetry findings showed an increased incidence of p reeclampsia, preterm birth, IUGR, and IUFD compared to those subjects with only elevated MSAFP (p<0.05). No differences were observed in the incidence of LBW. Positive predictive values of adverse obstetric outcomes were sign ificantly higher in the group having both elevated MSAFP and abnormal Doppl er velocimetry compared to the group with only elevated MSAFP (p < 0.05). U terine artery Doppler velocimetry in the second trimester can improve the v alue of unexplained MSAFP elevation in the prediction of adverse obstetric outcomes.