TRANSVAGINAL DOPPLER ULTRASOUND OF THE UTEROPLACENTAL CIRCULATION IN THE EARLY PREDICTION OF PREECLAMPSIA AND INTRAUTERINE GROWTH-RETARDATION

Objective To evaluate the predictive value of transvaginal Doppler ult rasound studies of the uterine and umbilical arteries in early pregnan cy, in identifying pregnant women at risk of subsequently developing p re-eclampsia, or the delivery of a small for gestational age infant. D esign A multivariate logistic regression of Z scores of Doppler indice s obtained fi om the uterine and umbilical arteries of 652 women with singleton pregnancies at 12 to 16 weeks of gestation. Measurements inc luded the presence or absence of a notch, bilateral (right and left wa veform) notching, vessel diameter, the resistance index, the pulsatili ty index, time averaged mean velocity (cm/s), maximum systolic velocit y (cm/s), and volume flow (mL/min). Stepwise logistic regression and m ultivariate analysis of all the parameters measured was used to constr uct several scoring systems. Main outcome measures Pre-eclampsia, birt hweight, preterm delivery. Results In women that developed complicatio ns, there was a trend towards increased resistance and reduced velocit y and volume flow. If bilateral notches were present there was an incr eased risk of pre-eclampsia (odds ratio [OR] 21.99, 95% CI 6.55-73.79) , premature delivery (OR 2.38, 95% CI 1.19-4.75), and the delivery of a small for gestational age baby (OR 8.63, 95% CI 3.95-18.84). Using m ultivariate analysis, a seven parameter model was selected (after remo val of vessel diameter, uterine and umbilical resistance index). This model produces a scoring system with a sensitivity of 92.9% and a spec ificity of 85.1% for the prediction of pre-eclampsia. A three paramete r model (bilateral notches, uterine resistance index, umbilical pulsat ility index) provides similar sensitivities, but lower specificities, when compared with the seven parameter model.Conclusion These data ind icate that there are differences in uterine and umbilical artery Doppl er blood flow indices at 12 to 16 weeks, in pregnancies with a normal or complicated outcome. Scoring systems derived from multivariate anal ysis of Doppler indices demonstrate the potential of being able to ide ntify, in early pregnancy, a group of women at increased risk of the s ubsequent development of pre-eclampsia, premature delivery, or the bir th of a small for gestational age baby.