Uterine artery grade II diastolic notch in predicting unfavorable perinatal outcome in hypertensive women

Abstract

Objective: To estimate the sensitivity and the specificity of grade II diastolic notch of uterine arteries Doppler spectrogram in predicting perinatal outcomes. Methods: 230 patients with the diagnosis of pregnancy induced hypertension, preeclampsia or chronic hypertension were involved into prospective clinical study that was performed in Kaunas University of Medicine Hospital from 2000 to 2002 year. Doppler velocimetry of uterine arteries was performed in all cases. Criteria used for the presence of a notch was defined as: a notch was considered to be present when there was a clearly defined upturn of the flow velocity waveform at the beginning of diastole and which was present in all the waveforms. The diastolic notch was graded in severity as described by Bromley et al. (1994): a grade I notch was defined as ’nadir’ in early diastole higher than half of the peak diastolic notch velocity. Grade II diastolic notch was defined as ’nadir’ in early diastole lower than half of the peak diastolic notch velocity. The outcoms of the pregnancy were evaluated according to the medical records. Results: The grade II proto-diastolic notch was observed in 23 cases. It was present in 23.1% (6 out of 26) of cases with chronic superimposed hypertension, in 18.2% (6 out of 33) of cases with severe pre-eclampsia and in 18.5% (5 out of 27) of cases with mild pre-eclampsia. The grade II proto-diastolic notch was observed in one woman (0.4%) of the control group (p < 0.0001). There were just 4 cases with bilateral grade II PN. The statistical analysis will be presented without regard to mono or bilaterality of grade II PN. The rate of low birthweight for gestation in hypertensive patients increased from 14.4% to 40.9% [p = 0.004, OR = 4.13 (95% CI 1.62–10.51)], the frequency of the admission to NICU increased from 11.5% to 45.5%[p < 0.0001, OR = 6.42 (95% CI 2.51–16.46)] in the presence of grade II P [...].