Mid-trimester uterine artery doppler in high risk pregnancies as a predictor of adverse pregnancy outcomes

Objectives: The present study aims at demonstrating an association between abnormal uterine artery doppler waveform in high risk pregnancies at 18-24 weeks of gestation and subsequent development of adverse pregnancy outcomes. Methods: Uterine artery doppler was performed in high risk pregnant women between 18-24 weeks of gestation attending antenatal OPD at ESIC Medical College, Sanathnagar, during the period between March 2018 to February 2019. Presence of pulsatality index (PI) >1.45 or presence of bilateral uterine artery notching was considered as abnormal doppler waveforms. Outcomes measured were preeclampsia, small for gestation (<10th centile), abruption and intrauterine fetal death. Results: Doppler examination was performed in 115 high risk pregnant women. 34.78% had abnormal doppler waveforms. Overall 42 (36.52%) women had Small for gestational age (SGA) babies and 31(26.95%) developed preeclampsia, of which 76% and 70% had abnormal doppler respectively. The sensitivity, specificity, PPV and NPV of PI > 1.45 and bilateral uterine artery notching for predicting preeclampsia were 70%,78.57%,55% and 88% respectively (95% CI 2.3361-8.9923;P value < 0.0001) and that for SGA being 76.19%,89.04%,80% and 86.67% respectively (95% CI 3.3013-10.904; P value <0.0001). Conclusion: Mid-trimester uterine artery doppler waveform analysis performed in high risk women have a high negative predictive value. Hence, women with normal doppler waveforms are unlikely to develop adverse pregnancy outcomes.