TY - JOUR
T1 - Added prognostic value of Doppler ultrasound for adverse perinatal outcomes
T2 - A pooled analysis of three cohort studies
AU - Flanagan, Madeline F.
AU - Vollgraff Heidweiller-Schreurs, Charlotte A.
AU - Li, Wentao
AU - Ganzevoort, Wessel
AU - de Boer, Marjon A.
AU - Vazquez-Sarandeses, Alicia
AU - Turan, Ozhan M.
AU - Bossuyt, Patrick M.
AU - Mol, Ben W. J.
AU - Rolnik, Daniel L.
N1 - Funding Information: BWM reports that he is supported by a National Health and Medical Research Council Investigator grant (GNT1176437), and has been a consultant for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. He has received research support from Merck and Guerbet. The other authors report no conflicts of interest. Conflict of Interests: Publisher Copyright: © 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
PY - 2023/2
Y1 - 2023/2
N2 - Background: Fetal growth restriction (FGR) is an obstetric complication associated with adverse perinatal outcomes. Doppler ultrasound can improve perinatal outcomes through monitoring at-risk fetuses and helping time delivery. Aim: To investigate the prognostic value of different Doppler ultrasound measurements for adverse perinatal outcomes. Materials: Individual participant data. Methods: We performed a pooled analysis on individual participant data. We compared six prognostic models using multilevel logistic regression, where each subsequent model added a new variable to a base model that included maternal characteristics. Estimated fetal weight (EFW) and four Doppler ultrasound measurements were added in turn: umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and mean uterine artery pulsatility index (mUtA PI). The primary outcome was a composite adverse perinatal outcome, defined as perinatal mortality, emergency caesarean delivery for fetal distress, or neonatal admission. Discriminative ability was quantified with area under the curve (AUC). Results: Three data sets (N = 3284) were included. Overall, the model that included EFW and UA PI improved AUC from 0.650 (95% CI 0.624–0.676) to 0.673 (95% CI 0.646–0.700). Adding more ultrasound measurements did not improve further the discriminative ability. In subgroup analysis, the addition of EFW and UA PI improved AUC in both preterm (AUC from 0.711 to 0.795) and small for gestational age pregnancies (AUC from 0.729 to 0.770), but they did not improve the models in term delivery or normal growth subgroups. Conclusions: Umbilical artery pulsatility index added prognostic value for adverse perinatal outcomes to the already available information, but the combination of other Doppler ultrasound measurements (MCA PI, CPR or UtA PI) did not improve further prognostic performance.
AB - Background: Fetal growth restriction (FGR) is an obstetric complication associated with adverse perinatal outcomes. Doppler ultrasound can improve perinatal outcomes through monitoring at-risk fetuses and helping time delivery. Aim: To investigate the prognostic value of different Doppler ultrasound measurements for adverse perinatal outcomes. Materials: Individual participant data. Methods: We performed a pooled analysis on individual participant data. We compared six prognostic models using multilevel logistic regression, where each subsequent model added a new variable to a base model that included maternal characteristics. Estimated fetal weight (EFW) and four Doppler ultrasound measurements were added in turn: umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and mean uterine artery pulsatility index (mUtA PI). The primary outcome was a composite adverse perinatal outcome, defined as perinatal mortality, emergency caesarean delivery for fetal distress, or neonatal admission. Discriminative ability was quantified with area under the curve (AUC). Results: Three data sets (N = 3284) were included. Overall, the model that included EFW and UA PI improved AUC from 0.650 (95% CI 0.624–0.676) to 0.673 (95% CI 0.646–0.700). Adding more ultrasound measurements did not improve further the discriminative ability. In subgroup analysis, the addition of EFW and UA PI improved AUC in both preterm (AUC from 0.711 to 0.795) and small for gestational age pregnancies (AUC from 0.729 to 0.770), but they did not improve the models in term delivery or normal growth subgroups. Conclusions: Umbilical artery pulsatility index added prognostic value for adverse perinatal outcomes to the already available information, but the combination of other Doppler ultrasound measurements (MCA PI, CPR or UtA PI) did not improve further prognostic performance.
KW - area under the curve
KW - growth restriction
KW - perinatal outcome
KW - prediction
KW - ultrasound
KW - umbilical artery pulsatility index
UR - http://www.scopus.com/inward/record.url?scp=85131552293&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ajo.13547
DO - https://doi.org/10.1111/ajo.13547
M3 - Article
C2 - 35678065
SN - 0004-8666
VL - 63
SP - 19
EP - 26
JO - Australian and New Zealand Journal of Obstetrics and Gynaecology
JF - Australian and New Zealand Journal of Obstetrics and Gynaecology
IS - 1
ER -