Uterine artery Doppler in high‐risk pregnancies at 23–24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance

OBJECTIVE: To assess the role of the placental arterial Doppler examination at 23-24 gestational weeks for predicting adverse perinatal outcome in high-risk pregnancies. DESIGN: Retrospective register study. SETTING: Skåne University Hospital in Malmö. POPULATION: Six hundred and forty-five women with high-risk pregnancies, without fetal malformations or chromosomal abnormalities. METHODS: Placental (uterine and umbilical artery) Doppler ultrasound examination at 23-24 gestational weeks. MAIN OUTCOME MEASURES: Adverse perinatal outcomes including preeclampsia, small-for-gestational age newborns (smaller than 3rd percentile or smaller than the 10th percentile), preterm delivery (<34 weeks or <37 weeks of gestation at delivery), cesarean section, admission to the neonatal intensive care unit and intra-uterine fetal death. RESULTS: Abnormal uterine artery Doppler values were detected in 45% of this high-risk group but abnormal umbilical artery Doppler indices were only seen in 3.7%. Adverse perinatal outcome increased significantly with increasing placental vascular impedance (p < 0.0001). There were seven cases of intrauterine fetal death and in five the uterine artery Doppler values at 23-24 weeks were abnormal. A strong correlation between abnormal uterine artery Doppler and preeclampsia was present, but not with other forms of hypertensive disorder. CONCLUSION: Placental Doppler screening at 23-24 weeks can be used in detecting pregnancies at risk of adverse outcome and in selecting cases for more intense surveillance. A surveillance plan is proposed based on Doppler screening at 23-24 weeks of gestation.