Samuel Parry1, Anthony Sciscione2, David M Haas3, William A Grobman4, Jay D Iams5, Brian M Mercer6, Robert M Silver7, Hyagriv N Simhan8, Ronald J Wapner9, Deborah A Wing10, Michal A Elovitz11, Frank P Schubert3, Alan Peaceman4, M Sean Esplin7, Steve Caritis8, Michael P Nageotte10, Benjamin A Carper12, George R Saade13, Uma M Reddy14, Corette B Parker12. 1. Departments of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine, Philadelphia, PA. Electronic address: parry@mail.med.upenn.edu. 2. Christiana Care Health System, Newark, DE. 3. Indiana University School of Medicine, Indianapolis, IN. 4. Feinberg School of Medicine, Northwestern University, Evanston, IL. 5. Ohio State University College of Medicine, Columbus, OH. 6. Case Western Reserve University School of Medicine, Cleveland, OH. 7. University of Utah School of Medicine, Salt Lake City, UT. 8. University of Pittsburgh School of Medicine, Pittsburgh, PA. 9. College of Physicians and Surgeons, Columbia University, New York, NY. 10. University of California, Irvine, School of Medicine, Irvine, CA; Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA. 11. Departments of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine, Philadelphia, PA. 12. RTI International, Research Triangle Park, NC. 13. University of Texas Medical Branch, Galveston, TX. 14. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Abstract
BACKGROUND: Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. OBJECTIVE: We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. STUDY DESIGN: Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. RESULTS: Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. CONCLUSION: In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.
BACKGROUND: Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. OBJECTIVE: We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. STUDY DESIGN: Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. RESULTS: Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. CONCLUSION: In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.
Authors: Samuel Parry; Benjamin A Carper; William A Grobman; Ronald J Wapner; Judith H Chung; David M Haas; Brian Mercer; Robert M Silver; Hyagriv N Simhan; George R Saade; Uma M Reddy; Corette B Parker Journal: Am J Obstet Gynecol Date: 2022-04-26 Impact factor: 10.693
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Authors: Debora Farias Batista Leite; Aude-Claire Morillon; Elias F Melo Júnior; Renato T Souza; Fergus P McCarthy; Ali Khashan; Philip Baker; Louise C Kenny; Jose Guilherme Cecatti Journal: BMJ Open Date: 2019-08-10 Impact factor: 2.692
Authors: E Hwuang; P H Wu; A Rodriguez-Soto; M Langham; F W Wehrli; M Vidorreta; B Moon; K Kochar; S Parameshwaran; N Koelper; M D Tisdall; J A Detre; W Witschey; N Schwartz Journal: Ultrasound Obstet Gynecol Date: 2021-10-07 Impact factor: 7.299
Authors: Eliza C Miller; Benjamin Carper; Natalie A Bello; C Noel Bairey Merz; Philip Greenland; Lisa D Levine; David M Haas; William A Grobman; Rebecca B McNeil; Judith H Chung; Jennifer Jolley; George R Saade; Robert M Silver; Hyagriv N Simhan; Ronald J Wapner; Corette B Parker Journal: Int J Cardiol Cardiovasc Risk Prev Date: 2021-08-12