One-stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation

Objective: To estimate the value of screening for preeclampsia and fetal gr owth restriction by performing color Doppler assessment of uterine arteries at 23 weeks' gestation in predicting adverse pregnancy outcome. Methods: Women with singlet-on pregnancies who attended routine ultrasonogr aphy at 23 weeks had color Doppler uterine artery imaging. Bilateral uterin e artery notches were noted and left and right uterine artery pulsatility i ndices (PI) were measured. A mean PI of more than 1.45 was considered incre ased. Screening characteristics for predicting preeclampsia and delivery of small-for-gestational-age infants were calculated. Results: Of 1757 pregnancies, increased PI was present in 89 (5.1%) and bil ateral notches were noted in 77 (4.4%). Twenty-three of 65 women (35.3%; 95 % confidence interval [CI] 23.9, 48.2) had increased PI and later developed preeclampsia, and 8 of 10 (80%; 95% CI 44.4, 97.5) with preeclampsia requi red delivery before 34 weeks. The respective values for women with bilatera l notches were 21 of 65 (32.3%; 95% CI 21.2, 45.1) and 8 of 10 (80%; 95% CI 44.4, 97.5). The sensitivity of increased PI was 30 of 143 (21%; 95% CI 14 .6, 28.6) for delivery of an infant with birth weight below the tenth perce ntile and 7 of 10 (70% 95% CI 34.8,93.3) for birth weight below the tenth p ercentile delivered before 34 weeks. The respective values for bilateral no tches were 19 of 143 (13.3%; 95% CI 8.2, 20) and 5 of 10 (50%; 95% CI 18.7, 81.3). Conclusion: A one-stage color Doppler screening program at 23 weeks identif ied most women who subsequently developed serious complications of impaired placentation associated with delivery before 34 weeks. The screening resul ts were similar when the high-risk group was defined as women with increase d PI or bilateral notches. (Obstet Gynecol 2000;96:559-64. (C) 2000 by The American College of Obstetricians and Gynecologists.).