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

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. We identified relevant studie...

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Published in:Canadian Medical Association journal (CMAJ) Vol. 178; no. 6; pp. 701 - 711
Main Authors: Cnossen, J. S., Morris, R. K., ter Riet, G., Mol, B. W.J., van der Post, J. A.M., Coomarasamy, A., Zwinderman, A. H., Robson, S. C., Bindels, P. J.E., Kleijnen, J., Khan, K. S.
Format: Journal Article
Language:English
Published: Canada CMA Impact Inc 11.03.2008
CMA Impact, Inc
Canadian Medical Association
Subjects:
Adult
Arteries - diagnostic imaging
Blood
Confidence Intervals
Diagnosis
Doppler ultrasonography
Female
Fetal Growth Retardation - diagnosis
Fetal Growth Retardation - epidemiology
Fetus
Growth retardation
Humans
Imaging
Incidence
Medical disorders
Medical research
Medical screening
Methods
Placental Circulation - physiology
Pre-Eclampsia - diagnosis
Pre-Eclampsia - epidemiology
Predictive Value of Tests
Preeclampsia
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pulsatile Flow
Risk Assessment
Risk factors
Sensitivity and Specificity
Systematic review
Ultrasonic imaging
Ultrasonography, Doppler
Ultrasonography, Prenatal
Uterus
Uterus - blood supply
Uterus - diagnostic imaging
Veins & arteries
ISSN:0820-3946, 1488-2329, 1488-2329
Online Access:Get full text
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Summary: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. 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. 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. 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.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.070430