Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women

Abstract

Objective: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry.

Study design: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression.

Results: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA.

Conclusion: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.