Jindal Sucheta, Dudley Nicholas, Batra Megha
United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, UK.
Ultrasound. 2025 Jul 20:1742271X251356785. doi: 10.1177/1742271X251356785.
In the United Kingdom, uterine artery Doppler ultrasound, specifically measurement of the pulsatility index, is recommended in the second trimester of pregnancies at risk of developing conditions like pre-eclampsia and fetal growth restriction, to facilitate timely monitoring and intervention. The aim of this study was to evaluate the effectiveness of uterine artery Doppler in detecting pregnancies at risk for adverse outcomes by analysing a cohort of high-risk pregnancies.
A total of 218 pregnancies were retrospectively selected post-delivery, having been identified prior to anomaly scanning as at high risk for adverse outcomes. They had bilateral uterine artery Doppler between 18 and 24 weeks of gestation as part of normal care. Mean uterine artery pulsatility index above the 95th percentile was considered abnormal. Subjects received close monitoring in the third trimester, including 2-3 weekly growth ultrasounds with umbilical artery Doppler, and regular blood pressure checks. Sensitivity, specificity, positive predictive value and negative predictive value of uterine artery Doppler were calculated to assess its predictive accuracy for pre-eclampsia and low birthweight.
Sensitivity of uterine artery Doppler > 95th percentile was 20% for pre-eclampsia (positive predictive value: 14%) and 46% for birthweight < 3rd centile (positive predictive value: 30%). Specificity was 80% for pre-eclampsia (negative predictive value: 86%) and 84% for birthweight < 3rd centile (negative predictive value: 91%).
Uterine artery Doppler pulsatility index alone has limited sensitivity for predicting pre-eclampsia, and small for gestational age births in a high-risk population. These findings underscore the need for multimodal approaches, incorporating other biomarkers and clinical risk factors.
在英国，对于有患先兆子痫和胎儿生长受限等疾病风险的妊娠，建议在孕中期进行子宫动脉多普勒超声检查，特别是测量搏动指数，以便及时监测和干预。本研究的目的是通过分析一组高危妊娠来评估子宫动脉多普勒在检测有不良结局风险的妊娠中的有效性。
共回顾性选取了218例产后妊娠，这些妊娠在异常扫描前被确定为有不良结局的高危妊娠。作为常规护理的一部分，她们在妊娠18至24周期间进行了双侧子宫动脉多普勒检查。子宫动脉搏动指数高于第95百分位数被认为异常。受试者在孕晚期接受密切监测，包括每2 - 3周进行一次生长超声检查及脐动脉多普勒检查，以及定期测量血压。计算子宫动脉多普勒的敏感性、特异性、阳性预测值和阴性预测值，以评估其对先兆子痫和低出生体重的预测准确性。
子宫动脉多普勒>第95百分位数对先兆子痫的敏感性为20%（阳性预测值：14%），对出生体重<第3百分位数的敏感性为46%（阳性预测值：30%）。对先兆子痫的特异性为80%（阴性预测值：86%），对出生体重<第3百分位数的特异性为84%（阴性预测值：91%）。
仅子宫动脉多普勒搏动指数对预测先兆子痫的敏感性有限，对高危人群中小于胎龄儿出生的预测能力也较小。这些发现强调了采用多模式方法的必要性，该方法应纳入其他生物标志物和临床风险因素。
