Uterine artery Doppler in the first trimester as a risk factor for adverse pregnancy outcomes: a meta-analysis involving 55,974 women

Velauthar, L., Plana, M. N., Kalidindi, M., Zamora, J., Thilaganathan, B., Illanes, S. E., Khan, K. S., Aquilina, J. and Thangaratinam, S. (2013) Uterine artery Doppler in the first trimester as a risk factor for adverse pregnancy outcomes: a meta-analysis involving 55,974 women. Ultrasound in Obstetrics and Gynecology, 43 5: 500-507. doi:10.1002/uog.13275

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Author Velauthar, L.
Plana, M. N.
Kalidindi, M.
Zamora, J.
Thilaganathan, B.
Illanes, S. E.
Khan, K. S.
Aquilina, J.
Thangaratinam, S.
Title Uterine artery Doppler in the first trimester as a risk factor for adverse pregnancy outcomes: a meta-analysis involving 55,974 women
Journal name Ultrasound in Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0960-7692
1469-0705
Publication date 2013-12-12
Sub-type Article (original research)
DOI 10.1002/uog.13275
Open Access Status DOI
Volume 43
Issue 5
Start page 500
End page 507
Total pages 23
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Objectives Pre-eclampsia and fetal growth restrictions are associated with adverse pregnancy outcomes, especially with an early onset. Clinical risk assessment of women is done in the first trimester to identify women for preventative treatment. 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 outcomes and performed data extraction to construct 2x2 tables. We synthesised sensitivity and specificity for various Doppler indices using bivariate random effect model.

Results From 1866 citations, we identified 18 studies (55, 974 women). The sensitivity and specificity of abnormal flow velocity waveform (FVW) for early onset pre-eclampsia were 47.8% (95% CI 39.0% to 56.8%) and 92.1% (95% CI 88.6% to 94.6%), and for early onset fetal growth restriction these were 39.2% (95% CI 26.3% to 53.8%) and 93.1% (95% CI 90.6% to 95.0%), respectively. The sensitivities for predicting any pre-eclampsia and fetal growth restriction were 26.4% (95% CI 22.5% to 30.8%) and 15.4% (95% CI 12.4% to 18.9%); the specificities were 93.4% (95% CI 90.4% to 95.5%) and 93.3% (95% CI 90.9% to 95.1%). The Number Needed to Treat (NNT) to prevent one case of early onset pre-eclampsia with aspirin fell from 1000 to 173 and from 2500 to 421 for background risks varying between 1% and 0.4% respectively.

Conclusions Uterine artery Doppler in the first trimester is a useful tool for predicting early onset pre-eclampsia amongst all pregnancy outcomes. Its performance is adequate for it to be considered as a risk factor for early onset pre-eclampsia to initiate early simple preventative measures like aspirin.
Keyword First trimester
Uterine artery Doppler
Pre-eclampsia
Fetal growth restriction
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Accepted manuscript online: 12 December 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2014 Collection
 
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Citation counts: TR Web of Science Citation Count  Cited 43 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 42 times in Scopus Article | Citations
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Created: Wed, 02 Apr 2014, 22:57:59 EST by Roheen Gill on behalf of UQ Centre for Clinical Research