Doppler Velocimetry Of Uterine And Umbilical Artery For The Prediction Of Adverse Pregnancy Outcome

Objective: To evaluate the usefulness of uterine artery early diastolic notch index and uterine and umbilical arterial resistance scores in predicting the adverse pregnancy outcome.Methods: Data were gathered and classified from 223 unselected womenwho underwent uterine and umbilical artery Doppler velocimetry for aroutine anomaly scan between 18+0 and 36+6 gestational weeks. Everyonewas performed uterine artery Doppler sonography on both sides and 147 werefollowed up to postpartum. Impedance of uterine and umbilical artery wasregistered using pulsatility indices (PI), resistance indices (RI), and systolicto diastolic velocity ratios (S/D). In case of notch, early diastolic notch index(NI) was defined as C/D with D=post-systolic nadir and C=following zenithof the waveform. Outcome variables were pregnancy-induced hypertension,intrauterine growth retardation (<10~th percentile on fetal growth curve) , fetalasphyxia (Apgar score ≤7), amniotic fluid contamination, intrauterine death,admission to neonatal intensive care unit (NICU), premature rupture ofmemberane, and preterm delivery before 37 gestational weeks. ROC curveswere created to measure the association between each predictor and thepresence of the adverse pregnancy outcome (P<0.05). Then we chose theoptimal cutoff to predict adverse pregnancy outcome. And the score wasestablished according to the optimal cutoff levels of those seven singlepredictors (total scores: 0—11). We created ROC curve of the score toascertain the adverse pregnancy outcome to choose the optimal one lorprediction.Results: 1. The PI, RI, S/D of uterine and umbilical artery decreased aspregnant weeks increased. While NI of uterine artery increased.2. We divided the pregnant weeks into three parts: 20+0-28+6 weeks, 29+0-32+6 weeks, and 33+0-36+6 weeks. The ROC curves of each predictor to ascertain adverse pregnancy outcome all appeared statistical significance (P < 0.05). The optimal cutoff of each predictor was:1) 20+0-28+6 weeks: uterine artery PK0.71; uterine artery RK0.49; uterine artery S/D< 1.95; uterine artery NI>0.926; umbilical artery PI< 1.00; umbilical artery RI<0.66; umbilical artery S/D<2.922 )29+0~32+6 weeks: uterine artery PK0.60; uterine artery RK0.44; uterine artery S/D< 1.82; uterine artery NI>0.928; umbilical artery PI< 0.92; umbilical artery RK0.61; umbilical artery S/D<2.59o3)33+0-36+6 weeks: uterine artery PK0.59; uterine artery RK0.43; uterine artery S/D< 1.73; uterine artery NI>0.949; umbilical artery PI< 0.78; umbilical artery RK0.57; umbilical artery S/D<2.25O 3. The predicting value of NI of uterine artery:1 )20+0~28+6 weeks, uterine artery NI^0.926,the sensitivity is 73.7%; the specificity is 52.4%; the positive likelihood ratio is 1.55; the negative likelihood ratio is 0.502; the positive predicative value is 58.3%; and the negative predicative value is 68.8%?2)29+0-32+6 weeks, uterine artery NI=^ 0.928, the sensitivity is 61.5%; the specificity is 61.4%; the positive likelihood ratio is 1.59; the negativelikelihood ratio is 0.627; the positive predicative value is 58.5%; and thenegative predicative value is 62.3%3 )33+0~36+6 weeks, uterine artery NI^O.949, the sensitivity is 83.3%;the specificity is 58.3%; the positive likelihood ratio is 2.00; the negativelikelihood ratio is 0.286; the positive predicative value is 66.7%; and thenegative predicative value is 77.8%o4. The scores combined uterine with umbilical artery for prediction ofadverse pregnancy outcome also appeared statistical significance (P < 0.05),and were much better than that of the each single predictor. The predictionvalue is:1) 20+0-28+6 weeks, scored, the sensitivity is 78.9%; the specificityis 76.2%; the positive likelihood ratio is 3.32; the negative likelihood ratio is0.276; the positive predicative value is 75.0%; and the negative predicative value is 80.0%.2)29+0-32+6 weeks, score^5, the sensitivity is 66.7%; the specificity is 72.7%; the positive likelihood ratio is 2.44; the negative likelihood ratio is 0.458; the positive predicative value is 68.4%; and the negative predicative value is 71.l%03)33+O~36+6 weeks, score^5, the sensitivity is 83.3%; the specificity is 75.0%; the positive likelihood ratio is 3.33; the negative likelihood ratio is 0.222; the positive predicative value is 76.9%; and the negative predicative value is 81.8%.Conclusion: This study suggests that evaluating notch index in the presence: of early diastolic notch on uterine artery velocimetry and Doppler sonography of the uterine and umbilical artery would be a useful method forpredicting adverse pregnancy outcomes.