Harrington K, Fayyad A, Thakur V, Aquilina J
The Homerton Hospital NHS Trust, Queen Mary and Westfield College, London, UK.
Ultrasound Obstet Gynecol. 2004 Jan;23(1):50-5. doi: 10.1002/uog.932.
To investigate the value of second-trimester uterine artery Doppler in the prediction of complications resulting from uteroplacental insufficiency in low- and high-risk multiparous women.
Color flow pulsed Doppler imaging of both uterine arteries at 20 weeks' gestation was performed on 628 multiparous women; 458 of them had no known risk factors and 170 had clinically identifiable high-risk factors at booking. An abnormal result was defined as bilateral notches and a mean resistance index (RI) >/= 0.55 (50th centile) or unilateral notches and a mean RI >/= 0.65 (80th centile). The main outcome measure was adverse pregnancy outcome defined as any case of pre-eclampsia, small-for-gestational age birth weight (< 5th centile), placental abruption, stillbirth or early neonatal death.
There was an adverse outcome in 30 women (6.6%) in the low-risk group and 48 (28.2%) women in the high-risk group. In the high-risk group the sensitivity to predict adverse pregnancy outcome in screen-positive women was 81.4% for a specificity of 89.0%, a positive predictive value of 71.4% and a negative predictive value of 93.4%. Normal Doppler studies in the high-risk group conferred a risk of adverse perinatal outcome of 6.6%, similar to the risk of adverse outcome in the low-risk population (6.6%). In the low-risk group the sensitivity for an adverse outcome in screen-positive women was 33.3% for a specificity of 92.8% and a positive predictive value of 24.4%.
In high-risk multiparous women, persistent bilateral notches with mean RI >/= 0.55 and unilateral notches with mean RI >/= 0.65 at 20 weeks' gestation identifies the vast majority of women who will subsequently develop complications secondary to uteroplacental insufficiency. Normal uterine artery Doppler studies in these women confers a risk of adverse outcome similar to that of women with an uncomplicated obstetric history. In low-risk women, the screening efficacy of uterine artery Doppler for adverse perinatal outcome is poor and does not justify routine screening.
探讨孕中期子宫动脉多普勒超声对预测低危和高危经产妇胎盘功能不全并发症的价值。
对628例经产妇在妊娠20周时进行双侧子宫动脉彩色血流脉冲多普勒成像检查；其中458例无已知危险因素，170例在登记时具有临床可识别的高危因素。异常结果定义为双侧切迹且平均阻力指数（RI）≥0.55（第50百分位数）或单侧切迹且平均RI≥0.65（第80百分位数）。主要结局指标为不良妊娠结局，定义为子痫前期、小于胎龄儿出生体重（<第5百分位数）、胎盘早剥、死产或早期新生儿死亡的任何病例。
低危组30例（6.6%）出现不良结局，高危组48例（28.2%）出现不良结局。在高危组中，筛查阳性女性预测不良妊娠结局的敏感性为81.4%，特异性为89.0%，阳性预测值为71.4%，阴性预测值为93.4%。高危组中多普勒检查正常者发生不良围产期结局的风险为6.6%，与低危人群不良结局风险（6.6%）相似。在低危组中，筛查阳性女性出现不良结局的敏感性为33.3%，特异性为92.8%，阳性预测值为24.4%。
在高危经产妇中，妊娠20周时持续双侧切迹且平均RI≥0.55以及单侧切迹且平均RI≥0.65可识别出绝大多数随后会因胎盘功能不全而发生并发症的女性。这些女性子宫动脉多普勒检查正常时发生不良结局的风险与产科病史无并发症的女性相似。在低危女性中，子宫动脉多普勒超声对不良围产期结局的筛查效果较差，不支持常规筛查。
