Journal of Ultrasound in Medicine, Vol 16, Issue 6 387-393, Copyright © 1997 by American Institute of Ultrasound in Medicine
Doppler velocimetry discordancy of the uterine arteries in pregnancies complicated by diabetes
L. A. Bracero, J. Evanco and D. W. Byrne
Department of Obstetrics and Gynecology, New York, Medical College, Westchester County Medical Center, Valhalla, USA.
The aim of this study was to examine the association between uterine artery
Doppler velocimetry discordance and perinatal outcome, specifically in
pregnancies complicated by diabetes. We evaluated 265 women with singleton
pregnancies complicated by diabetes who underwent Doppler ultrasonographic
examinations of the right and left uterine arteries within 1 week before
delivery. The absolute difference between the right and left uterine
arteries was computed after measuring the uterine artery systolic-diastolic
ratio. Adverse outcome was defined as still-birth, intrauterine growth
restriction, delivery before 37 weeks' gestation, or cesarean delivery for
fetal risk. The discordance between right and left uterine artery
systolic-diastolic ratios ranged from 0 to 2.3, with a mean of 0.39 +/-
0.36 and a median of 0.30. The discordance was significantly larger in the
63 pregnancies with adverse outcome than in those with good outcome (0.48
versus 0.36, P = 0.018). Among the women with large uterine artery S/D
ratio differences (> or = 0.60), a cesarean delivery for fetal risk was
three times more likely (21.5% versus 7.5%, P = 0.002). In diabetic women
with chronic hypertension (n = 36), the discordance was significantly
larger than in the 201 normotensive women (0.54 versus 0.35, P = 0.001);
yet for this subgroup uterine artery S/D ratio discordance was not
predictive of adverse outcome. In conclusion, although considerable overlap
in discordance exists between the good and adverse outcome groups, the
uterine artery S/D ratio discordance added prognostic information on
perinatal outcome for normotensive women with diabetes. The predictive
value is independent of White's classification, third trimester glycemic
control, sex of the infant, and umbilical artery Doppler waveform data.
