Determinants of adverse perinatal outcome in high-risk women with abnormal uterine artery Doppler images

• Published in: American journal of obstetrics and gynecology Vol. 198; no. 3; pp. 330.e1 - 330.e7
• Main Authors: Toal, Meghana, MBBS, Keating, Sarah, MD, Machin, Geoff, MD, Dodd, Jodie, MD, PhD, Adamson, S. Lee, PhD, Windrim, Rory C., MB, MSc, Kingdom, John C.P., MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-03-2008; Elsevier
• Subjects: Adolescent; Adult; Arteries - diagnostic imaging; Biological and medical sciences; Cardiovascular system; Female; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Obstetrics and Gynecology; perinatal outcome; Placenta Diseases - diagnostic imaging; placental disease; placental morphologic condition; Pregnancy; Pregnancy Outcome; Prognosis; Prospective Studies; Risk Factors; Ultrasonic investigative techniques; Ultrasonography, Doppler; uterine artery Doppler imaging; Uterus - blood supply; placental morphologic condition; uterine artery Doppler imaging; placental disease; perinatal outcome; pregnancy; Sonography; Human; Doppler ultrasound study; High risk; Determinant; Gynecology; Perinatal; Image; Uterine artery; Obstetrics; Newborn; Adult; Complication; Female; Woman
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.09.031

Objective The purpose of this study was to evaluate the prognostic role of placental ultrasound imaging at 19-23 weeks of gestation in clinically high-risk women with abnormal uterine artery Doppler (UTAD). Study Design Placentas of 60 women with abnormal UTAD were examined at 19-23 weeks of gestation for shape and texture abnormalities. Findings were correlated with clinical outcomes (preterm delivery at <32 weeks of gestation; birth weight <10th percentile [small for gestational age]; preeclampsia/hemolysis, elevated liver enzymes, low platelets; early-onset intrauterine growth restriction with abnormal umbilical artery Doppler; and intrauterine fetal death) and maternal serum screening data. Placental disease was reviewed by 2 perinatal pathologists. Results Women with abnormal placental shape at 19-23 weeks of gestation (n = 28) had higher odds of intrauterine fetal death (odds ratio, 4.5; 95% CI, 1.3-15.6), delivery at <32 weeks of gestation (odds ratio, 4.7; 95% CI, 1.6-14.1]), and intrauterine growth restriction (odds ratio, 4.7; 95% CI, 1.4-15.1]) than did the women with a normal placental shape. Thirty-two of 41 placentas (74%) weighed <10th percentile, and 36 of 43 placentas (83%) had ischemic-thrombotic pathologic condition. There was no association between abnormal placental shape at 19-23 weeks of gestation and placental weight, but 5 of 6 placentas that were <10 cm long were <10th percentile for weight at delivery. There was a poor correlation between measures of ultrasound texture at 19-23 weeks of gestation and the presence of specific lesions at delivery. Conclusion Combined abnormal UTAD and placental dysmorphologic condition before fetal viability identifies a subset of women who are at risk of adverse outcomes. Placental size is critical in the determination of the outcome in this situation because of the very high prevalence of destructive lesions, although present methods of placental imaging have significant limitations.