DOPPLER VELOCIMETRY DISCORDANCY OF THE UTERINE ARTERIES IN PREGNANCIES COMPLICATED BY DIABETES

The aim of this study was to examine the association between uterine a rtery Doppler velocimetry discordance and perinatal outcome, specifica lly in pregnancies complicated by diabetes. We evaluated 265 women wit h singleton pregnancies complicated by diabetes who underwent Doppler ultrasonographic examinations of the right and left uterine arteries w ithin 1 week before delivery The absolute difference between the right and left uterine arteries was computed after measuring the uterine ar tery systolic-diastolic ratio. Adverse outcome was defined as stillbir th, intrauterine growth restriction, delivery before 37 weeks' gestati on, or cesarean delivery for fetal risk. The discordance between right and left uterine artery systolic-diastolic ratios ranged from 0 to 2. 3, with a mean of 0.39 +/- 0.36 and a median of 0.30. The discordance was significantly larger in the 63 pregnancies with adverse outcome th an in those with good outcome (0.48 versus 0.36, P = 0.018). Among the women with large uterine artery S/D ratio differences (greater than o r equal to 0.60), a cesarean delivery for fetal risk was three times m ore likely (21.5% versus 7.5%, P = 0.002). Ln diabetic women with chro nic hypertension (n = 36), the discordance was significantly larger th an in the 201 normotensive women (0.54 versus 0.35, P = 0.001); vet fo r this subgroup uterine artery S/D ratio discordance was not predictiv e of adverse outcome. Ln conclusion, although considerable overlap in discordance exists between the good and adverse outcome groups, the ut erine artery S/D ratio discordance added prognostic information on per inatal outcome for normotensive women with diabetes. The predictive va lue is independent of White's classification, third trimester glycemic control, sex of the infant, and umbilical artery Doppler waveform dat a.