Doppler-Sonographiescreening der A. uterina in der gynäkologischen Praxis
| Autor: | M. Carstensen, D. Masson, U. Schuman, C. Felixmüller, H. Hille, J. Pferdmenges, D. Geisen-Neuroth, U. Mattner, M. Voß |
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| Rok vydání: | 2003 |
| Předmět: | |
| Zdroj: | Geburtshilfe und Frauenheilkunde. 63:56-62 |
| ISSN: | 1438-8804 0016-5751 |
| Popis: | Purpose: To evaluate uterine artery Doppler screening in decentralized routine antenatal care for selection of pregnancies with high risk for severe pre-eclampsia and intrauterine growth restriction. Material and Methods: In a period of 18 months all single pregnant women with confirmed consent to the procedure were examined by a two-stage-screening (19.- 22. and 26.-28. weeks of gestation) by means of abdominal CFM Doppler ultrasound of the uterine arteries in 8 different specialised practices. 680 (low-risk) pregnant women were collected consecutively without selection, 214 women had been referred from different reasons for level 2 ultrasound and were segregated as a high-risk-group. An early diastolic notch and/or a PI = > 1.3 were deemed to be pathologic, leading to the second stage of examination. Screening characteristics in the prediction of severe pre-eclampsia, intrauterine growth restriction and the necessity for early delivery before 36th week of gestation were calculated and compared with the results published by clinical centres. Results: Analysing any waveform of uterine artery Doppler of either side with pathologic characteristics the sensitivity for pre-eclampsia reaches 74% and 51% for IUGR, the specificity was 86% each. Analysing only cases with severe pathologic characteristics (mean PI > = 1.3 and/or deep notches bilaterally) the specificity increases to 96% by decreasing sensitivity to 49%, respectively 29%. But the PPV for any specific complication during pregnancy (pre-eclampsia, IUGR, preterm delivery) increases to 63% with a more than 37-fold risk for induced preterm delivery before 36th week of gestation. Using a score ranging from 0-3 analysing the Doppler waveforms of both sides, the individual risk for specific complications could be predicted sufficiently. The results of this trial under decentralized conditions of care compare approximately with the ones of referral centres. Conclusions: Even under decentralized conditions of antenatal care uterine artery Doppler screening is able to detect pregnancies with high risk for severe pre-eclampsia and/or IUGR in a content manner. Under aspects of possible therapeutic consequences, this method of examination should be accepted in routine antenatal care. |
| Databáze: | OpenAIRE |
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