A prospective analysis of the role of uterine artery Doppler waveform notching in the assessment of at-risk pregnancies

Objective. To determine the value of second trimester uterine artery Doppler waveform notching in the prediction of adverse pregnancy outcome in a high-risk group. Design. Analysis of data from a consecutively collected cohort. Setting. St. James University Hospital, Leeds, UK. Population. Three hundred thirty women known to be at risk of preeclampsia (PET) or intrauterine growth restriction (IUGR) were assessed for notching of the uterine artery Doppler waveform between 24-30 weeks of pregnancy. Main Outcome Measures. Preeclampsia (PET), small-for-gestational-age at birth (SGA), preterm delivery (PTD), perinatal death. Results. Two hundred thirty-two women (70.3%) had a normal uterine artery Doppler waveforms, and 98 (29.7%) demonstrated either unilateral or bilateral notching. In women where notching was present, 20 (20%) developed PET compared with 8 (3.5%) in the normal group [Odds ratio (OR) 7.2, CI 3-17]; SGA birthweight was present in 24 (24.5%) of the notched group and in 21 (9%) of normal group (OR 3.3; Cl 1.7-6.2); 40 (41%) of the notched group delivered preterm (< 37 weeks) as compared with 37 (16%) of the normal group (OR 7.9; Cl 4.6-13). This difference was even more marked when delivery before 32 weeks was considered, occurring in 8 (8%) of the notched group and 4 (1.7%) of the normal group (OR 11.5; Cl 4.5-29.4). Of the six perinatal deaths, five (5.1%) occurred in the notched group (OR 12.4; CI 1.4-108). Conclusion. This study demonstrates that the addition of uterine Doppler waveform analysis to the monitoring profile of women at risk of PET, SGA, IUD and preterm delivery can further define those in a higher risk group and the majority that have a risk no higher than the background.