Early Doppler ultrasound screening in prediction of hypertensive disorders of pregnancy.

1198 nulliparous women were screened in early pregnancy (median 18 weeks' gestation) by the recording of doppler ultrasound waveforms from the uteroplacental circulation. After exclusions, the results of 1014 women were available for analysis; 118 (12%) of them had persistently abnormal waveforms on repeat ultrasound scans at 24 weeks and were taken to have a positive test result. Hypertension was significantly more frequent among those women than among women with normal doppler waveforms (29/118 [25%] vs 45/896 [5%]). In addition, hypertension in women with abnormal waveforms was more likely to be severe; 12 (10%) had proteinuria and 15 (13%) intrauterine growth retardation compared with 7 (0.8%) and 0, respectively, of those with normal waveforms. Overall, the test did poorly when assessed by standard statistical means. However, the sensitivity was high for hypertension associated with either proteinuria (63%) or intrauterine growth retardation (100%). The test is cheap, easy to carry out, and non-invasive, and it can be done in early pregnancy; it is therefore a useful means of identifying a high-risk group of pregnant women suitable for therapeutic intervention to reduce the incidence of hypertensive disorders and their complications.