Can Artery Doppler Studies Predict Small for Gestational Age Neonates?
BACKGROUND AND PURPOSE:
Artery Doppler flow studies can be used to detect impeded artery blood flow and potentially predict adverse pregnancy outcomes
Predictive value in unselected populations remains low
Perry et al. (AJOG, 2017) sought to determine the utility of routine, early second trimester uterine artery Doppler studies as a predictor of small for gestational age (SGA) neonates
Observational prospective cohort study
Nulliparous patients were recruited through the Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)
8,024 women with singleton pregnancies and successful Doppler studies were included for analysis
Three indices of uterine artery Doppler flow of both arteries were measured between 16 weeks 0 days and 22 weeks 6 days gestation
Receiver operating curves (ROCs) that take in to account sensitivity and specificity as well as typical thresholds for the uterine artery Doppler measurements (diastolic notch depth >1, 5, and 20 cm/sec; RI>0.58; and PI>1.60) were assessed
Transabdominal approach used first, with vaginal approach when transabdominal inadequate
Repeated at 22 weeks 0 days to 29 weeks 6 days if there was a diastolic notch
SGA defined as birth weight <5th percentile for gestation age at delivery
Preeclampsia or gestational hypertension
Spontaneous preterm birth
Typical thresholds for the uterine artery Doppler indices were all associated with SGA
However, areas under receiver operating characteristic curves (AUC) ranged from 0.56 to 0.62 which indicates poor screening discrimination between disease and normal
Negative predictive values were all >90% but positive predictive values were all < 15%
An adjusted prediction model, considering clinical risk factors such as smoking history, resulted in only modest improvements in the AUCs ranging from 0.63 to 0.66
ROC curves for secondary outcomes were likewise between 0.52 and 0.60
Negative predictive values for all three secondary outcomes was 87% but positive predictive value was < 22%
Early second trimester uterine artery Doppler studies does not accurately predict SGA nor preeclampsia, gestational hypertension, preterm birth or stillbirth
Routine uterine artery Doppler studies are not clinically useful for predicting SGA babies
Use and research should focus on high risk patients
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