Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance

ObjectiveTo assess the role of the placental arterial Doppler examination at 23-24 gestational weeks for predicting adverse perinatal outcome in high-risk pregnancies. DesignRetrospective register study. SettingSkane University Hospital in Malmo. PopulationSix hundred and forty-five women with high-risk pregnancies, without fetal malformations or chromosomal abnormalities. MethodsPlacental (uterine and umbilical artery) Doppler ultrasound examination at 23-24 gestational weeks. Main outcome measuresAdverse perinatal outcomes including preeclampsia, small-for-gestational age newborns (smaller than 3rd percentile or smaller than the 10th percentile), preterm delivery (<34weeks or <37weeks of gestation at delivery), cesarean section, admission to the neonatal intensive care unit and intra-uterine fetal death. ResultsAbnormal uterine artery Doppler values were detected in 45% of this high-risk group but abnormal umbilical artery Doppler indices were only seen in 3.7%. Adverse perinatal outcome increased significantly with increasing placental vascular impedance (p<0.0001). There were seven cases of intrauterine fetal death and in five the uterine artery Doppler values at 23-24weeks were abnormal. A strong correlation between abnormal uterine artery Doppler and preeclampsia was present, but not with other forms of hypertensive disorder. ConclusionPlacental Doppler screening at 23-24weeks can be used in detecting pregnancies at risk of adverse outcome and in selecting cases for more intense surveillance. A surveillance plan is proposed based on Doppler screening at 23-24weeks of gestation.