RT Journal Article
SR Electronic
T1 Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 701
OP 711
DO 10.1503/cmaj.070430
VO 178
IS 6
A1 Jeltsje S. Cnossen MD
A1 Rachel K. Morris MD
A1 Gerben ter Riet, MD PhD
A1 Ben W.J. Mol, MD PhD
A1 Joris A.M. van der Post, MD PhD
A1 Arri Coomarasamy MD
A1 Aeilko H. Zwinderman, MSc PhD
A1 Stephen C. Robson MD
A1 Patrick J.E. Bindels, MD PhD
A1 Jos Kleijnen, MD PhD
A1 Khalid S. Khan MD
YR 2008
UL http://www.cmaj.ca/content/178/6/701.abstract
AB Background: Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results: We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients. Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests.