Prediction of adverse pregnancy outcomes by uterine artery doppler imaging at 22-24 weeks of pregnancy: A north Indian experience

Aims: The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes.
Methods: This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation of 165 pregnant women with singleton pregnancies. A pulsatility index (PI) more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or atleast one adverse outcome.
Results: Out of 165 patients, 35 (21.2%) had abnormal second trimester uterine artery Doppler. In the pregnancies resulting in preeclampsia (PE, n=21), fetal growth restriction (FGR, n=21) and low birth weight (n=39) the median uterine artery PI was higher (1.52, 1.41 and 1.27 respectively).. In the presence of abnormal Doppler, the risk of PE (OR=10.7, 95% CI= 3.91-29.1; p < 0.0001), FGR (OR=4.34, 95% CI = 1.62-11.6; p = 0.002), low birth weight (OR=6.39, 95% CI=3.16-12.9; p < 0.001) and the risk of atleast one obstetrical complication (OR= 8.73, 95% CI=3.5-21.3; p < 0.0001) was significantly high. The positive predictive value of abnormal uterine artery Doppler was maximum for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.
Conclusion: Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of atleast one adverse pregnancy outcome, with the highest prediction for preeclampsia.

Keywords: Uterine artery Doppler, preeclampsia, fetal growth restriction, low birth weight, adverse obstetric outcome