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Predictive accuracy of the first trimester Doppler scan: a meta-study
1New European Surgical Academy (NESA) and Emory University, Atlanta, USA, obgynvienna@myway.com.
Wiener Medizinische Wochenschrift (1946)
|June 17, 2015
Summary
Uterine artery Doppler (UAD) effectively predicts preeclampsia and fetal growth restriction (FGR). Its predictive accuracy improves after 16 weeks of gestation, with placental location influencing results.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Diagnostic Imaging
Background:
- Preeclampsia and fetal growth restriction (FGR) are significant complications of pregnancy.
- Early prediction is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the sensitivity and cut-off indices of uterine artery Doppler (UAD) for predicting preeclampsia and FGR.
- To identify optimal screening parameters and gestational timing for UAD.
Main Methods:
- Systematic review and meta-analysis of 76 studies (1995-2014) involving 298,329 prenatal Doppler screenings.
- Analysis of Doppler findings in nulliparous women during the first and early second trimesters.
- Stratification of data based on sensitivity, specificity, and clinical endpoints.
Main Results:
- Uterine artery Doppler (UAD) accuracy is influenced by placental bed characteristics and screening mode, with specificity correlations of 0.728 for FGR and 0.803 for bilateral notching.
- Predictive sensitivity of UAD increases significantly after 16 weeks + 3 days of gestation.
Conclusions:
- Uterine artery Doppler (UAD) is a valuable tool for predicting preeclampsia and FGR.
- The placental side uterine artery resistance index is the most effective predictor, particularly when the placenta is located on the midline (OR 0.9).
- Optimal screening timing is after 16 weeks + 3 days gestation.
