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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1603-1610 • 0278-4297

Umbilical Artery Doppler Indices in Small for Gestational Age Fetuses

Correlation With Adverse Outcomes and Placental Abnormalities

Jeffrey M. Dicke, MD, Phyllis Huettner, MD, Sida Yan, Anthony Odibo, MD and Frederick T. Kraus, MD

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, Missouri USA.

Address correspondence to Jeffrey M. Dicke, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, 4990 Children’s Pl, Suite 1130, St Louis, MO 63110 USA. E-mail: dickej{at}wustl.edu

Objective. The purpose of this study was to compare the screening efficiency of the umbilical artery systolic to diastolic ratio (S/D), pulsatility index (PI), and absent end-diastolic flow (AEDF) for adverse pregnancy outcomes and placental abnormalities in small for gestational age (SGA) fetuses. Methods. We conducted a retrospective cohort study of Doppler examinations of 161 nonanomalous SGA fetuses. The reliability of the S/D and PI were quantified by intraclass correlation coefficients. The association of the S/D, PI, and AEDF with adverse outcomes and placental abnormalities was compared by the {chi}2 test. Results. There was a simple association of Doppler results with adverse outcomes, which was mitigated when controlled for gestational age. For all measures of adverse outcomes, the specificity of abnormal Doppler results exceeded the sensitivity, and the negative predictive value was greater than the positive predictive value. Comparing the S/D with the PI, there was no significant difference in the sensitivity; however, the specificity of the PI was at least 90% and exceeded that of the S/D for all outcomes. The intraclass correlation coefficients of the S/D and PI were similar, indicating no difference in reliability. Placental abnormalities were significantly more common in cases with abnormal Doppler values (positive predictive value, 94%) with no overlap in the types of placental lesions in most cases. Conclusions. As an initial screen for adverse outcomes in SGA fetuses, the umbilical artery Doppler S/D, PI, and AEDF were imprecise. However, these measures were all strongly and similarly predictive of placental abnormalities, especially lesions of maternal underperfusion and fetal vascular obstruction.

Key Words: placenta • small for gestational age • umbilical artery Doppler indices

Abbreviations: AEDF, absent end-diastolic flow • IUGR, intrauterine growth restriction • LR, likelihood ratio • NICU, neonatal intensive care unit • NPV, negative predictive value • NRFS, nonreassuring fetal status • PI, pulsatility index • PPV, positive predictive value • S/D, systolic to diastolic ratio • SGA, small for gestational age

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.