D'Alton ME; FASTER Trial Research Consortium. First trimester uterine artery Doppler abnormalities predict subsequent intrauterine growth restriction

Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 10/2005; 193(3 Pt 2):1208-12. DOI: 10.1016/j.ajog.2005.06.054
Source: PubMed


This study was undertaken to evaluate the association between uterine artery Doppler velocimetry performed between 10 and 14 weeks gestation and intrauterine growth restriction (IUGR).
Uterine artery Doppler velocimetry data were collected on 1067 women enrolled in the FASTER trial at the University of Colorado site. The data were analyzed by using univariate and multivariable logistic regression analysis.
The uterine artery mean resistance index (RI) for the entire cohort was equal on the right and left sides (0.59 +/- 0.14). Of the 1067 women, 34.2% had unilateral or bilateral diastolic notches, 1 notch was observed in 23.8%, and bilateral notches in 10.4%. Women with a high uterine artery mean RI (> or = 75th percentile) were 5.5 times more likely to have IUGR (95% CI 1.6-18.7). There was no significant relationship between notching and IUGR.
Elevated first trimester uterine artery mean RI is significantly associated with IUGR.

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    • "Martin et al. reported that increased uterine Doppler PI at 11 to 14 weeks had a sensitivity of 11.7% for detecting birth weight less than the 10th percentile, and 27.8% for FGR requiring delivery by 32 weeks gestation [84]. Others have reported sensitivities of 24% and 16% [85, 86]. Despite these low sensitivities, women with a high uterine artery mean RI (greater or equal to the 75th percentile) are 5.5 times more likely to have an FGR pregnancy [86]. "
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    ABSTRACT: Fetal growth restriction (FGR) remains a leading contributor to perinatal mortality and morbidity and metabolic syndrome in later life. Recent advances in ultrasound and Doppler have elucidated several mechanisms in the evolution of the disease. However, consistent classification and characterization regarding the severity of FGR is lacking. There is no cure, and management is reliant on a structured antenatal surveillance program with timely intervention. Hitherto, the time to deliver is an enigma. In this paper, the challenges in the diagnosis and management of FGR are discussed. The biophysical profile, Doppler, biochemical and molecular technologies that may refine management are reviewed. Finally, a model pathway for the clinical management of pregnancies complicated by FGR is presented.
    Journal of pregnancy 04/2011; 2011(2090-2727):640715. DOI:10.1155/2011/640715
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    • "On the other hand, risk factor assessment may provide a backdrop or pretest probability that can be improved by other predictive tests. For example, the performance of uterine artery Doppler and maternal serum analyte is influenced by maternal risk factors (Antsaklis et al., 2000; Dugoff et al., 2005; Spencer et al., 2008c). Thus, these factors can help identify high risk populations in which predictive test may perform better (Conde- Agudelo et al., 2004). "
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    ABSTRACT: Preeclampsia and intrauterine growth restriction (IUGR) are major contributors to perinatal mortality and morbidity worldwide. Both are characterized by impaired trophoblastic invasion of the maternal spiral arteries and their conversion from narrow muscular vessels to wide non-muscular channels. Despite improvement in the understanding of the pathophysiology of these conditions, ability to accurately identify pregnant woman who will develop them is limited. This greatly impairs the development and testing of preventive interventions. While different measures of placental dysfunction have been associated with increased risk for adverse pregnancy outcomes, the ability of any single one to accurately predict these outcomes is poor. Developing predictive tests is further challenged by difficulty in the timing of the measurements, as both the structural and biochemical characteristics of the placenta change with increasing gestational age. The ideal screening test would accurately predict the development of adverse pregnancy outcomes early enough to provide a window for preventive interventions. Improvement in ultrasound technology provides potentially useful novel tools for evaluating placental structure, but measurements need to be standardized in order to be useful. Maternal serum analyte screening is a noninvasive test of placental biochemical function, but present serum marker alone is not sufficiently accurate to suggest its routine use in clinical practice. The use of first trimester biochemical markers in combination with uterine artery Doppler screening is promising as a potential screening tool. Prospective longitudinal studies using standardized methodology are necessary to further evaluate the choice of parameters and strategies of combination to achieve the best predictive models.
    Prenatal Diagnosis 04/2010; 30(4):293-308. DOI:10.1002/pd.2475 · 3.27 Impact Factor
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    • "Accurate early pregnancy markers for placental dysfunction that predict impending adverse outcomes would allow efficient clinical management and surveillance of women at risk, thereby reducing the gravity of these conditions. Potential early pregnancy markers under investigation include Doppler ultrasound of the uterine artery in the first trimester (Dugoff et al., 2005; Spencer et al., 2005), decreased first-trimester pregnancy associated plasma protein -A (PAPP-A) (Dugoff et al., 2004; *Correspondence to: Kevin Spencer, Prenatal Screening Unit, Department of Clinical Biochemistry, King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB. UK. "
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    ABSTRACT: In a previous study, reduced levels of maternal serum placental protein 13 (PP13) in the first trimester have been correlated with adverse pregnancy outcomes. The objective of this study was to compare first-trimester PP13 levels in control pregnancies with pregnancies resulting in one or more of the following adverse outcomes: intrauterine growth restriction (IUGR), small and very small (3rd, 5th, 10th centile) for gestational age (SGA), low (<1.5 and < 2.5 kg) birth weight (LBW), macrosomia (the > 90th centile), large birth weight (>4.5 kg), preterm (35-36 weeks) and very early (<34 weeks) delivery (PTD), and intrauterine fetal demise (IUFD). Maternal serum samples from 1940, 11 to 14 weeks singleton pregnancies, were assayed for PP13 and the concentrations were corrected for gestational age, maternal weight, smoking status, and ethnic origin. A comparison of the levels of PP13 in 364 controls and 1576 adverse outcome categories was made. PP13 levels were expressed in terms of both concentration and multiple of medians (MoMs). Comparison of PP13 MoMs from SGA, PTD, and low birth weight samples with control pregnancy samples showed no statistically significant difference. In macrosomic pregnancies (>90th centile), levels of PP13 were significantly higher than controls (p = 0.0263) although the number of cases in this study was small. Decreased levels of PP13 were not significantly correlated with the studied adverse pregnancy outcomes of IUGR, PTD low birth weight, and IUFD. Further studies are required to evaluate if measurement of PP13 has any value in the early assessment of pregnancies.
    Prenatal Diagnosis 02/2008; 28(2):121-5. DOI:10.1002/pd.1921 · 3.27 Impact Factor
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