First-trimester uterine artery Doppler and adverse pregnancy outcome: A meta-analysis involving 55 974 women

L. Velauthar, M. N. Plana, M. Kalidindi, J. Zamora, B. Thilaganathan, S. E. Illanes, K. S. Khan, J. Aquilina, S. Thangaratinam

Research output: Contribution to journalArticlepeer-review

135 Scopus citations

Abstract

Objectives To determine the accuracy with which uterine artery Doppler in the first trimester of pregnancy predicts pre-eclampsia and fetal growth restriction, particularly early-onset disease. Methods We searched MEDLINE (1951-2012), EMBASE (1980-2012) and the Cochrane Library (2012) for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of first-trimester uterine artery Doppler to predict adverse pregnancy outcome and performed data extraction to construct 2 × 2 tables. We synthesized sensitivity and specificity for various Doppler indices using a bivariate random-effects model. Results From 1866 citations, we identified 18 studies (55 974 women). The sensitivity and specificity of abnormal uterine artery flow velocity waveform (FVW) in the prediction of early-onset pre-eclampsia were 47.8% (95% CI: 39.0-56.8) and 92.1% (95% CI: 88.6-94.6), and in the prediction of early-onset fetal growth restriction were 39.2% (95% CI: 26.3-53.8) and 93.1% (95% CI: 90.6-95.0), respectively. The sensitivities for predicting any pre-eclampsia and fetal growth restriction were 26.4% (95% CI: 22.5-30.8) and 15.4% (95% CI: 12.4-18.9), respectively, and the specificities were 93.4% (95% CI: 90.4-95.5%) and 93.3% (95% CI: 90.9-95.1), respectively. The number needed to treat (NNT) with aspirin to prevent one case of early-onset pre-eclampsia fell from 1000 to 173 and from 2500 to 421 for background risks varying between 1% and 0.4%, respectively. Conclusions First-trimester uterine artery Doppler is a useful tool for predicting early-onset pre-eclampsia, as well as other adverse pregnancy outcomes. Based on the NNT, abnormal uterine artery Doppler in low-risk women achieves a sufficiently high performance to justify aspirin prophylaxis in those who test positive.

Original languageEnglish
Pages (from-to)500-507
Number of pages8
JournalUltrasound in Obstetrics and Gynecology
Volume43
Issue number5
DOIs
StatePublished - May 2014

Bibliographical note

Copyright © 2013 ISUOG.
Published by John Wiley & Sons Ltd.

Keywords

  • fetal growth restriction
  • first trimester
  • pre-eclampsia
  • uterine artery Doppler

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