Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes

Objectives: Our aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA). Study design: This retrospective cohort study examined outcomes of patients with >= one abnormal analyte (PAPP-A < 0.3, hCG > 3.0, AFP > 2.5, inhibin > 2.0, or unconjugated estriol < 0.3MoM). At approximately 24 weeks, we assessed UtA pulsatility index (PI). Main outcome measures: Preeclampsia, preterm preeclampsia, SGA (birthweight (BW) < 10%) and intrauterine growth restriction (IUGR) (BW < 3%). Results: We identified 132 patients with >= one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI > 1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)). Conclusions: In patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9-15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome. (C) 2014 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.