The use of Doppler velocimetry of the umbilical artery before 24 weeks' gestation to screen for high-risk pregnancies
The original publication is available at http://www.samj.org.za
Objective. To describe the prevalence and natural history of absent end-diastolic velocities (AEDV) in the umbilical artery of the fetus between 16 and 24 weeks' gestation, and to evaluate its role as a screening test. Design. Population-based descriptive study. Setting. Tygerberg Hospital, Tygerberg, South Africa. The hospital serves a population from the lower socio-economic bracket. Subjects. Doppler velocimetry was performed at routine ultrasound examinations for confirmation of gestational age in 496 women. Main outcome measures. The occurrence of perinatal death, small-for-gestational-age (SGA) babies and proteinuric hypertension. Results. Forty-four (8,9%) patients had AEDVs at the first examination, but AEDV persisted in only 1. In this case, severe proteinuric hypertension developed unexpectedly at 29 weeks' gestation ahd the fetus needed delivery because of persistent late decelerations of the fetal heart rate pattern. There was a significant association between the group with AEDV at first examination and the development of proteinuric hypertension (P < 0,05), but no association with SGA babies. The association with proteinuric hypertension was too weak to be of clinical use. Conclusion. Doppler velocimetry of the umbilical artery, performed along with routine ultrasound examination to confirm gestational age, is not of use as a screening test for identifying high-risk pregnancies.
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