Adverse perinatal outcomes are strongly associated with degree of abnormality in uterine artery Doppler pulsatility index.

IF 6.1 1区 医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2024-10-01 Epub Date: 2024-09-05 DOI:10.1002/uog.27668
S Dockree, C Aye, C Ioannou, A Cavallaro, R Black, L Impey
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Abstract

Objective: To investigate the association between varying degrees of abnormality in the Doppler uterine artery pulsatility index (UtA-PI) and adverse perinatal outcome.

Methods: This was a prospective study of women with a singleton, non-anomalous pregnancy in whom UtA-PI was measured universally in midpregnancy and who gave birth in Oxford University Hospitals, Oxford, UK, between 2016 and 2023. Relative risk ratios (RRR) for the primary outcomes of extended perinatal mortality and live birth with a severe small-for-gestational-age (SGA) neonate were calculated using multinomial logistic regression, for early preterm birth (before 34 + 0 weeks' gestation) and late preterm/term birth (at or after 34 + 0 weeks). Risks were also investigated for iatrogenic preterm birth and a composite adverse outcome before 34 + 0 weeks.

Results: Overall, 33 364 pregnancies were included in the analysis. Compared to those with a normal UtA-PI, the risk of extended perinatal mortality with delivery before 34 + 0 weeks was higher in women with UtA-PI ≥ 90th percentile (RRR, 4.7 (95% CI, 2.7-8.0); P < 0.001), but this was not demonstrated in births at or after 34 + 0 weeks. The risk of live birth with severe SGA was associated strongly with abnormal UtA-PI for early births (RRR, 26.0 (95% CI, 11.6-58.2); P < 0.001) and later births (RRR, 2.3 (95% CI, 1.8-2.9); P < 0.001). Women with raised UtA-PI were more likely to have an early iatrogenic birth (RRR, 7.8 (95% CI, 5.5-11.2); P < 0.001). For each outcome before 34 + 0 weeks and the composite outcome, the risk increased significantly in association with the degree of abnormality in the UtA-PI (from < 90th, 90-94th, 95-98th to ≥ 99th percentile) (Ptrend < 0.001). When using the 90th percentile as opposed to the 95th, there was a significant improvement in the overall predictive accuracy (as determined by the area under the receiver-operating-characteristics curve) for the composite adverse outcome (χ2 = 6.64, P = 0.01) and iatrogenic preterm birth (χ2 = 4.10, P = 0.04).

Conclusions: Elevated UtA-PI is a key predictor of iatrogenic preterm birth, severe SGA and perinatal loss up to 34 + 0 weeks' gestation. The 90th percentile for UtA-PI should be used, and management should be tailored according to the degree of abnormality, as pregnancies with very raised UtA-PI measurement constitute a group at extreme risk of adverse outcome. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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不利的围产期结果与子宫动脉多普勒搏动指数的异常程度密切相关。
目的研究子宫动脉多普勒搏动指数(UtA-PI)不同程度的异常与围产期不良结局之间的关系:方法:对 33,364 名在牛津出生的单胎非畸形婴儿的妇女进行前瞻性研究,在孕中期对 UtA-PI 进行普遍测量。通过多项式逻辑回归计算了早期早产(+0)和晚期早产/早产(≥34+0)的围产期死亡率延长和活产时出现严重小于胎龄(SGA)的主要结果的相对风险比。此外,还对先天性早产或 34+0 周前的综合不良结果的风险进行了调查:结果:与 UtA-PI 正常的妇女相比,UtA-PI > 90th 百分位数的妇女在 34+0 周前围产期死亡的风险更高(RRR 4.7,95% CI 2.7-8.0,pth、90-94th、95-99th 和 >99th 百分位数):UtA-PI升高是预测34+0周以内的先天性早产、严重SGA和围产期死亡的关键指标。应使用第 90 百分位数,并应根据异常程度进一步调整管理,因为 UtA-PI 测量值非常高的孕妇构成了一个极度危险的群体。本文受版权保护。保留所有权利。
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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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