Association of Uterine Artery Doppler Resistance Index and Birth Weight: Effect of Customized Birth Weight Standards

ABSTRACT

We assessed the effect of using customized birth-weight standards on the association of uterine artery Doppler resistance index (RI) and birth weight. This was a cross-sectional study of 2035 pregnancies scanned at 19 to 23 weeks. Both uterine arteries were identified using color flow mapping, and the RI was measured. The pregnancy outcome was obtained from the delivery suite database and the customized birth-weight centile calculated for each pregnancy. Both birth-weight and customized birth-weight centiles were converted to z-scores. The correlation of uterine artery RI with birth weight was examined using conventional and customized birth-weight standards. Conventional and customized birth weights showed a significant correlation with uterine artery RI (r = −0.062 and −0.208, respectively). The correlation was significantly improved by the use of customized birth weight. Use of customized birth weight significantly improves the correlation of uterine artery RI and birth weight. This finding may partly explain the lower sensitivity of uterine artery Doppler screening for fetal growth restriction as compared with preeclampsia.

KEYWORDS

Uterine artery Dopplers - customized birth weight - growth restriction

REFERENCES

• 1 Brosens J J, Pijnenborg R, Brosens I A. The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature.  Am J Obstet Gynecol. 2002;  187 1416-1423
• 2 Kohnen G, Kingdom J. Villous development and the pathogenesis of IUGR. In: Kingdom J, Baker P Intrauterine Growth Restriction. London; Springer 2000: 131-147
• 3 Kam E P, Gardner L, Loke Y W, King A. The role of trophoblast in the physiological change in decidual spiral arteries.  Hum Reprod. 1999;  14 2131-2138
• 4 Brosens I A. Morphological changes in the utero-placental bed in pregnancy hypertension.  Clin Obstet Gynaecol. 1977;  4 573-593
• 5 Hecher K, Rizzo G, Nicolaides K Fetal and Placental Dopplers. London, New York; The Parthenon Publishing Group 2000
• 6 Wilcox M, Gardosi J, Mongelli M, Ray C, Johnson I. Birth weight from pregnancies dated by ultrasonography in a multicultural British population.  BMJ. 1993;  307 588-591
• 7 Pearce J M, Campbell S, Cohen-Overbeek T, Hackett G, Hernandez J, Royston J P. References ranges and sources of variation for indices of pulsed Doppler flow velocity waveforms from the uteroplacental and fetal circulation.  Br J Obstet Gynaecol. 1988;  95 248-256
• 8 Bland M. An Introduction to Medical Statistics. 3rd ed. Oxford; Oxford University Press 2000: 201
• 9 Customized centile calculator PC Windows computer program version 5.2 Available at: http://wmpi.net/
• 10 Gardosi J, Chang A, Kalyan B, Sahota D, Symonds E M. Customized antenatal growth charts.  Lancet. 1992;  339 283-287
• 11 Mongelli M, Gardosi J. Reduction of false-positive diagnosis of fetal growth restriction by application of customized fetal growth standards.  Obstet Gynecol. 1996;  88 844-848
• 12 Campbell S, Diaz-Recasens J D, Griffin D R et al.. New Doppler technique for assessing uteroplacental blood flow.  Lancet. 1983;  1 675-677
• 13 Campbell S, Pearce J, Hackett G, Cohen-Overbeek T, Hernandez C. Qualitative assessment of uteroplacental blood flow: early screening test for high-risk pregnancies.  Obstet Gynecol. 1986;  68 649-653
• 14 Newnham J P, Patterson L L, James I R, Diepeveen D A, Reid S E. An evaluation of the efficacy of Doppler flow velocity waveform analysis as a screening test in pregnancy.  Am J Obstet Gynecol. 1990;  162 403-410
• 15 Bewley S, Cooper D, Campbell S. Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation.  Br J Obstet Gynaecol. 1991;  98 871-879
• 16 Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of pre-eclampsia and intrauterine growth retardation.  Br J Obstet Gynaecol. 1993;  100 989-994
• 17 North R A, Ferrier C, Long D, Townend K, Kincaid-Smith P. Uterine artery Doppler flow velocity waveforms in the second trimester for the prediction of preeclampsia and fetal growth retardation.  Obstet Gynecol. 1994;  83 378-386
• 18 Irion O, Masse J, Forest J C, Moutquin J M. Prediction of pre-eclampsia, low birth-weight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women.  Br J Obstet Gynaecol. 1998;  105 422-429
• 19 Papageorghiou A T, Yu C K, Bindra R, Pandis G et al.. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation.  Ultrasound Obstet Gynecol. 2001;  18 441-449
• 20 de Jong C L, Gardosi J, Dekker G A, Colenbrander G J, Van Geijn H P. Application of a customized birth-weight standard in the assessment of perinatal outcome in a high-risk population.  Br J Obstet Gynaecol. 1998;  105 531-535
• 21 Aquilina J, Barnett A, Thompson O, Harrington K. Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre-eclampsia.  Ultrasound Obstet Gynecol. 2000;  16 163-170
• 22 Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined by customized versus population-based birth-weight standards.  BJOG. 2001;  108 830-834
• 23 The investigation and management of the small-for-gestational-age fetus. Clinical Green-top guideline No. 31. Royal College of Obstetricians and Gynecologists. November 2002
• 24 Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customized antenatal growth charts.  Br J Obstet Gynaecol. 1999;  106 309-317
• 25 Campbell S, Black R, Lees C, Armstrong V, Peacock J. Doppler ultrasound of the maternal uterine arteries: disappearance of abnormal waveforms and relation to birth-weight and pregnancy outcome.  Acta Obstet Gynecol Scand. 2000;  79 631-634
• 26 Cnossen J S, Morris R K, ter Riet G et al.. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis.  CMAJ. 2008;  178 701-711