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indices predict adverse pregnancy outcome in uncomplicated pregnancies with borderline-low amniotic fluid index in the early third trimester Kazumasa Hashimoto, Tania Kasdaglis, Sheveta Jain, Ozhan Turan, Kristin Atkins, Jerome Kopelman, Chris Harman, Ahmet Baschat University of Maryland School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, University of Maryland School of Medicine, Obstetrics & Gynecology and Reproductive Sciences, Baltimore, MD OBJECTIVE: We have reported borderline-low (BL) amniotic fluid index (AFI) in the early third trimester in uncomplicated pregnancy associated with adverse outcome. The aim of this study is to test if maternal and/or fetal Doppler indices can stratify risks of adverse perinatal outcome. STUDY DESIGN: Nested case-control study in cohort of uncomplicated pregnancy with BL-AFI (8.0-11.9) at 28.0-31.9 weeks gestation (20062010, N 173). Frequency of abnormal uterine artery Doppler pulsatility index (UtA PI), umbilical artery (UA PI) and middle cerebral artery (MCA PI) were compared between controls and those with adverse outcome, defined in categories: Antepartum (abnormal antepartum testing, stillbirth, placental abruption, preeclampsia, N 9), Delivery (emergency and/or fetal-indicated Cesarean delivery, preterm birth, N 52), Neonatal (birth weight 1.645 (90th centile) for UA PI and UtA PI, and Z-score 1.645 (10th centile) for MCA PI, defined abnormal values. RESULTS: Abnormal UtA, UA, and MCA-PI were significantly more common in all categories of adverse outcome, compared to controls. When any Doppler index is abnormal, prediction of adverse outcome had the following characteristics: Antepartum sensitivity (SN 0.88), specificity (SP 0.80), positive predictive value (PPV 0.26) and negative predictive value (NPV 0.99); Delivery (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Neonatal (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Composite (SN 0.39, SP 0.85, PPV 0.63, NPV 0.67). While individual Doppler indices had clinically-low predictive ability, combining UtA, UA, and MCA PI increases SN and NPV. CONCLUSION: Using these parameters, maternal and fetal Dopplers can identify cases at high-risk for adverse outcome in uncomplicated patients with borderline AFI. Measurement of all three Doppler indices helps triage such pregnancies. |
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