The predictive value of 18 and 22 week uterine artery Doppler in patients with low first trimester maternal serum PAPP-A

• Published in: Prenatal diagnosis 2009-03, Vol.29 (3), p.248-252
• Main Authors: Cooper, Stephanie, Johnson, Jo-Ann M., Metcalfe, Amy, Pollard, Jeffery, Simrose, Rebecca, Connors, Gregory, Jones, Donna, Roggensack, Anne, Krause, Richard, Lange, Ian
• Format: Article
• Language: English
• Subjects: Algorithms; Arteries - diagnostic imaging; Biological and medical sciences; Biomarkers - blood; Delivery. Postpartum. Lactation; Female; Fundamental and applied biological sciences. Psychology; Genetics of eukaryotes. Biological and molecular evolution; Gynecology. Andrology. Obstetrics; Humans; Infant, Low Birth Weight; Infant, Newborn; Medical sciences; Molecular and cellular biology; Odds Ratio; PAPP-A; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Second; Pregnancy-Associated Plasma Protein-A - analysis; Premature Birth; prenatal screening; Prospective Studies; Pulsatile Flow; Ultrasonography, Prenatal; uterine artery Doppler; Uterus - blood supply
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.2175

Objective To determine if the addition of uterine artery (UA) Doppler pulsatility index (PI) at 18 and 22 weeks of gestation improves the predictive accuracy of low first trimester pregnancy associated plasma protein A (PAPP‐A) in the detection of adverse obstetrical outcomes. Methods This was a prospective interventional study. All women undergoing first trimester combined screening (FTS) at a single center, with a low maternal serum PAPP‐A level ( 1.45. Primary outcomes were obtained from chart review, and logistic regression analysis was used to compare outcomes with positive and negative tests. Positive and negative predictive value, specificity and sensitivity were calculated. Results Between January and October 2007, 5359 women completed FTS. Among the low PAPP‐A group (n = 289), 18 week UA Doppler was a significant predictor of low birth weight (OR = 2.28, p = 0.04) while 22 week UA Doppler significantly predicted preterm birth (OR = 12.6, p = 0.001), small for gestational age (OR = 8.24, p = 0.001) and low birth weight (OR = 2.28, p = 0.04). Test characteristics suggested improved positive and negative predictive value for Doppler at 22 versus 18 weeks for these outcomes. Conclusions UA Doppler at 22 weeks is a useful adjunct in patients with low PAPP‐A. However, a negative Doppler does not rule out all adverse outcomes and clinical judgment is advised in the management of these patients. Copyright © 2009 John Wiley & Sons, Ltd.