Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen, Jeltsje S.; Morris, Rachel K.; ter Riet, Gerben; Mol, Ben W. J.; van der Post, Joris A. M.; Coomarasamy, Arri; Zwinderman, Aeilko H.; Robson, Stephen C.; Bindels, Patrick J. E.; Kleijnen, Jos; Khan, Khalid S.
March 2008
CMAJ: Canadian Medical Association Journal;3/11/2008, Vol. 178 Issue 6, p701
Academic Journal
Background: Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results: We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients. Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests.


Related Articles

  • Follow-up study of small-for-dates babies. Fancourt, Robin; Campbell, Stuart; Harvey, David; Norman, A.P. // British Medical Journal;6/12/1976, Vol. 1 Issue 6023, p1435 

    Examines the intrauterine growth of small-for-dates babies by using serial ultrasonic cephalometry. Detection of slow skull growth in utero; Assessment of the growth pattern; Effect of growth failure on the babies.

  • Early screening for IUGR: comparison of two related echographic markers. Walid, Mohammad Sami; Pomortsev, Alexei Victorovich // Archives of Gynecology & Obstetrics;Apr2009, Vol. 279 Issue 4, p551 

    Can ultrasonography be performed in pregnant women as a screening test to predict IUGR? To justify its use, it must have a high enough positive predictive value. This study addresses the concept of early prediction of IUGR using echographic measurements in the first trimester. We studied one...

  • Cardiac adaptation to training and decreased training loads in endurance athletes: a systematic review. F. J. Calderón Montero; P. J. Benito Peinado; Valter Di Salvo; Fabio Pigozzi; Nicola Maffulli // British Medical Bulletin;Dec2007, Vol. 84 Issue 1, p25 

    Introduction Changes in echocardiographic standard measurements as a consequence of training and detraining in elite or subelite athletes have not been comprehensively studied. Methods We identified 200 potentially relevant studies from 1966 to June 2006 and eliminated 187 studies that did not...

  • Detection of intrauterine growth retardation by ultrasound: preliminary communication. Ellis, Cheryl; Bennett, M. J. // Journal of the Royal Society of Medicine;Oct1981, Vol. 74 Issue 10, p739 

    In this study, ultrasonic measurements of the fetal head area and abdominal area were obtained in 1200 patients with singleton pregnancies. The results from the 434 who have delivered, indicate that a large proportion of growth-retarded infants cannot be identified by a single late ultrasonic...

  • Comparison of m-mode echocardiographic left ventricular mass measured using digital and strip chart readings: The Atherosclerosis Risk in Communities (ARIC) study. Arnett, Donna K.; Skelton, Thomas N.; Liebson, Philip R.; Benjamin, Emelia; Hutchinson, Richard G. // Cardiovascular Ultrasound;2003, Vol. 1, p8 

    Background: Epidemiological and clinical studies frequently use echocardiography to measure LV wall thicknesses and chamber dimension for estimating quantitative measures of LV mass. While echocardiographic M-mode LV images have traditionally been measured using hand-held calipers and...

  • ACP Guidelines on Screening for Osteoporosis in Men. ARMSTRONG, CARRIE // American Family Physician;10/1/2008, Vol. 78 Issue 7, p882 

    The article focuses on the guidelines of the American College of Physicians (ACP) on screening for osteoporosis in men. The use of the osteoporosis self-assessment screening tool is explained. A combination of calcaneal ultrasonography with confirmatory dual-energy x-ray absorptiometry (DEXA)...

  • Reliability of Carotid Doppler performed in a dedicated Stroke Prevention Clinic. Dean, N.; Lari, H.; Saqqur, M.; Amir, N.; Khan, K.; Mouradian, M.; Salam, Abdul; Romanchuk, H.; Shuaib, A. // Canadian Journal of Neurological Sciences;Aug2005, Vol. 32 Issue 3, p327 

    Assesses the accuracy of Doppler ultrasound (DUS) when performed in a dedicated stroke prevention clinic. Features of the DUS screening tool; Misclassification rate of DUS; Reliability of DUS in detecting complete internal carotid artery occlusion.

  • Quantitative ultrasound: measurement considerations for the assessment of muscular dystrophy and sarcopenia. Harris-Love, Michael O.; Monfaredi, Reza; Ismail, Catheeja; Blackman, Marc R.; Cleary, Kevin // Frontiers in Aging Neuroscience;Jul2014, Vol. 6, p1 

    The authors discuss the use of sonography in assessing muscle damage due to muscular dystrophy and changes in body and tissue composition associated with sarcopenia. They stress that the application quantitative diagnostic ultrasound has different technical challenges than to the use of...

  • Patients with small abdominal aortic aneurysms should 'wait and see'. Gottlieb, Scott // BMJ: British Medical Journal (International Edition);5/18/2002, Vol. 324 Issue 7347, p1175 

    States that two studies suggest that patients with small abdominal aortic aneurysms are safer adopting a wait and see approach rather than having immediate surgery to repair the weakened vessel. Details of British research by Roger Greenhalgh et al on survival in patients who had early surgery;...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics