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Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes.
J Ultrasound Med 2015; 34(7):1265-9JU

Abstract

OBJECTIVES

To investigate the optimal definition of abnormal first-trimester uterine artery Doppler parameters associated with adverse pregnancy outcomes.

METHODS

A prospective cohort of women with singleton gestations between 11 and 14 weeks consented to uterine artery Doppler measurements. Doppler parameters were measured bilaterally, and mean pulsatility index (PI) and resistive index (RI) values were calculated. The presence of notching was also determined. Each parameter was evaluated for prediction of preeclampsia, early preeclampsia (<34 weeks), preterm birth (<37 weeks), early preterm birth (<34 weeks), and small for gestational age (SGA; birth weight <10th percentile). Descriptive statistics evaluated the association between abnormal Doppler indices and outcomes. A receiver operating characteristic (ROC) analysis was used to define the best cutoff points for mean PI and RI. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated for bilateral notching and mean PI and RI percentiles.

RESULTS

Of 1192 patients with complete outcome data, preeclampsia was seen in 8.4%, early preeclampsia in 1.8%, preterm birth in 12.9%, early preterm birth in 5.6%, and SGA in 8.5%. A mean PI above the 75th percentile (>1.91) was the best index for predicting early preeclampsia (sensitivity, 45.0%; specificity, 75.5%; NPV, 98.7%; ROC area, 0.65). A mean PI above the 75th percentile was also the best index for predictive early preterm birth (sensitivity, 40.0%; specificity, 76.0%; NPV, 95.5%; ROC area, 0.65). None of the parameters were significant for predicting SGA.

CONCLUSIONS

A mean uterine PI above the 75th percentile is the most discriminative abnormal uterine artery Doppler parameter for predicting both early preeclampsia and early preterm birth.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.). cartere@wudosis.wustl.edu.Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA (E.B.C., K.G., M.G.T., A.G.C., G.A.M.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida USA (L.O., A.O.O.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26112630

Citation

Carter, Ebony B., et al. "Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes." Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, vol. 34, no. 7, 2015, pp. 1265-9.
Carter EB, Goetzinger K, Tuuli MG, et al. Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes. J Ultrasound Med. 2015;34(7):1265-9.
Carter, E. B., Goetzinger, K., Tuuli, M. G., Odibo, L., Cahill, A. G., Macones, G. A., & Odibo, A. O. (2015). Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, 34(7), pp. 1265-9. doi:10.7863/ultra.34.7.1265.
Carter EB, et al. Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes. J Ultrasound Med. 2015;34(7):1265-9. PubMed PMID: 26112630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes. AU - Carter,Ebony B, AU - Goetzinger,Katherine, AU - Tuuli,Methodius G, AU - Odibo,Linda, AU - Cahill,Alison G, AU - Macones,George A, AU - Odibo,Anthony O, PY - 2015/6/27/entrez PY - 2015/6/27/pubmed PY - 2016/4/5/medline KW - obstetric ultrasound KW - preeclampsia KW - pregnancy outcome KW - preterm birth KW - small for gestational age KW - uterine artery Doppler parameters SP - 1265 EP - 9 JF - Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine JO - J Ultrasound Med VL - 34 IS - 7 N2 - OBJECTIVES: To investigate the optimal definition of abnormal first-trimester uterine artery Doppler parameters associated with adverse pregnancy outcomes. METHODS: A prospective cohort of women with singleton gestations between 11 and 14 weeks consented to uterine artery Doppler measurements. Doppler parameters were measured bilaterally, and mean pulsatility index (PI) and resistive index (RI) values were calculated. The presence of notching was also determined. Each parameter was evaluated for prediction of preeclampsia, early preeclampsia (<34 weeks), preterm birth (<37 weeks), early preterm birth (<34 weeks), and small for gestational age (SGA; birth weight <10th percentile). Descriptive statistics evaluated the association between abnormal Doppler indices and outcomes. A receiver operating characteristic (ROC) analysis was used to define the best cutoff points for mean PI and RI. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated for bilateral notching and mean PI and RI percentiles. RESULTS: Of 1192 patients with complete outcome data, preeclampsia was seen in 8.4%, early preeclampsia in 1.8%, preterm birth in 12.9%, early preterm birth in 5.6%, and SGA in 8.5%. A mean PI above the 75th percentile (>1.91) was the best index for predicting early preeclampsia (sensitivity, 45.0%; specificity, 75.5%; NPV, 98.7%; ROC area, 0.65). A mean PI above the 75th percentile was also the best index for predictive early preterm birth (sensitivity, 40.0%; specificity, 76.0%; NPV, 95.5%; ROC area, 0.65). None of the parameters were significant for predicting SGA. CONCLUSIONS: A mean uterine PI above the 75th percentile is the most discriminative abnormal uterine artery Doppler parameter for predicting both early preeclampsia and early preterm birth. SN - 1550-9613 UR - https://www.unboundmedicine.com/medline/citation/26112630/Evaluating_the_Optimal_Definition_of_Abnormal_First_Trimester_Uterine_Artery_Doppler_Parameters_to_Predict_Adverse_Pregnancy_Outcomes_ L2 - https://doi.org/10.7863/ultra.34.7.1265 DB - PRIME DP - Unbound Medicine ER -