1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com UTERINE ARTERY VELOCIMETRY AT MIDGESTATION AND ADVERSE PREGNANCY OUTCOME IN LOW RISK PRIMIGRAVIDAE Angela Emanuel, Prof. Syeda Batool Mazhar Maternal and Child Health Center, Pakistan Institute of Medical Sciences, Islamabad, Pakistan Objectives Results Conclusions References To determine the relationship between abnormal uterine artery velocimetry at midgestation and adverse pregnancy outcome in low risk primigravidae Methods OPTIONAL LOGO HERE A cross sectional comparative study was conducted including 172 women,presenting at MCH center,Pakistan institute of Medical sciences, from : March,2009 – March, 2010,fulfilling the inclusion criteria. Inclusion Criteria: ● Primigravidae ● Booked <24 weeks ● Singleton gestation Exclusion Criteria: Congenital Fetal Anomaly History of HTN, DM, Connective tissue disorders Referred Uterine artery Doppler done at 20- 24 weeks Resistance Index(RI), Pulsatilty Index (PI) and presence of diastolic notch noted Criteria for Abnormal Test RI > 0.5 PI > 1.45 Diastolic notch in uterine artery VariableMean ±SD Maternal Age ( years)24 ±2.71 Body Mass Index(kg/ m 2 )23.2±3.5 Gestational Age at delivery (weeks) 38±3.5 Gestational Age at Uterine Doppler 21±1.1 Variablen(%) Normal127(73%) SGA30(17.4%) PIH13(7.5%) Pre-eclampsia14(8%) APH3(2%) IUD2(1.7) NICU admission03(17.4%) PIH, SGA, Preeclampsia, PlacentalAbruption, PTL, IUD NICU Admission Outcome measures Statistics Chi- Square test was used to find out the significance of Abnormal uterine artery Doppler in prediction of adverse pregnancy outcome Characteristics of the study cohort (n= 172) Uterine artery Doppler in study cohort Pregnancy Outcome in study cohort (n=172) Abnormal uterine doppler & adverse pregnancy outcome Type of Pregnanc y Sensitivity (%) Specificity (%) PPV (%) NPV (%) PIH22942095 Pre- eclampsia 61862796 SGA4904189 Abnormal uterine artery Doppler is associated with adverse peri-natal outcome. Abnormal uterine artery Doppler is associated with adverse peri-natal outcome. Does not qualify as a screening tool in low risk population due to low sensitivity. Does not qualify as a screening tool in low risk population due to low sensitivity. If resources available this test should be done at 20 to 24 weeks during the anatomical survey as it is not time consuming and is cost-effective. If resources available this test should be done at 20 to 24 weeks during the anatomical survey as it is not time consuming and is cost-effective. Screening Characteristics 2 nd trimester Resistance Index for adverse pregnancy outcome Type of Pregnanc y Sensitivity (%) Specificity (%) PPV (%) NPV (%) PIH76%94%1192 Pre- eclampsia 3897595 SGA28988185 Screening Characteristics 2 nd trimester Pulsatilty Index for adverse pregnancy outcome Discussion Previous studies have reported a sensitivity of 33.3% and a specificity of 92.8% in prediction of adverse outcome in low risk pregnancies Whether RI or PI is a superior parameter in prediction of adverse outcome- controversial Due to low sensitivity Uterine artery Doppler is not an effective screening tool Discussion Costa SL, Proctor L, Dodd JM, Toal M, Okun N, Johnson JA, etal.Screening for placental insufficiency in high-risk pregnancies: is earlier better? Placenta. 2008; 29:1034-40. Costa SLProctor LDodd JMToal MOkun NJohnson JA Park YW, Lim JC, Kim YH, Kwon HS. Uterine artery Doppler velocimetry during mid-second trimester to predict complications of pregnancy based on unilateral or bilateral abnormalities. Yonsei Med J. 2005 31; 46):652-7.Park YWLim JCKim YHKwon HS Vainio M, Kujansuu E, Koivisto AM, Mäenpää J. Bilateral notching of uterine arteries at 12--14 weeks of gestation for prediction of hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand. 2005; 84:1062-7.Vainio MKujansuu EKoivisto AMMäenpää J Simanaviciūte D. [Significance of early diastolic notch in the prognosis of unfavorable pregnancy outcome] Medicina (Kaunas). 2003;39:659-68.Simanaviciūte D