[Value of Doppler of the uterine arteries and the association of uterine and umbilical velocimetry in pregnancies at risk]

Abstract

This study was designed to evaluate the role of Doppler velocimetry of uterine artery and of the association of uterine and umbilical artery. We use the index of Stuart S/D to characterize the uterine waveform. A value greater than or equal to 3 and/or the persistence of a notch is considered abnormal. When the uterine artery is pathological, we find more proteinuric hypertension, the incidence of intrauterine growth retardation (IURG) twice (p less than 0.001), the birthweight is significantly lower; the caesarean section rate for fetal distress is 35% for 11% in the other group (p less than 0.005), but the caesarean section rate for maternal indication is the same in the two groups. If we test the efficiency of the uterine Doppler study in prediction IUGR, we obtain a sensitivity of 42.5% and a positive predictive value of 74%. The population of high risk pregnancies is divided into four groups according to the Doppler findings. The first group contain normal values in the uteroplacental circulation and in the umbilical vessels, this association predict a normal outcome. The second group contain normal umbilical artery flow velocity waveform (FVW) and abnormal uteroplacental FVW, this pattern is associated with more severe hypertension and a rate of caesarean section of 16%. The final two groups contain patients with abnormal umbilical FVW and either normal or abnormal uteroplacental FVW. We find in these two groups the more complicated neonatal evolution, the incidence of caesarean section for fetal distress is more than 50%, the rate of IUGR is between 82% and 100%. The examination of the uteroplacental vessels permit the selection of patients with high risk of chronic fetal distress, therefore these pregnancies will have intensive surveillance with biophysical profile, umbilical and cerebral Doppler.