FU Berlin Digitale Dissertation
Hans-Walter Vollert : Diagnostic and Clinical Value of Doppler Sonography of the Uterine Arteries at 20 - 23 Weeks of Gestation in a Low Risk Population Diagnostische und klinische Wertigkeit der Dopplersonographie der beiden Arteriae uterinae in einem "low-risk"-Kollektiv zwischen der 21. und 24. Schwangerschaftswoche
|Abstract| |Table of Contents| |More Information|

Abstract Objective: To identify the definition of pathological waveform which optimises the diagnostic value of Doppler sonography of the uterine arteries (DSUA) at 20-23 gestational weeks as a screening procedure in a low risk population Patients and methods: In a prospective study, 7502 singleton pregnancies with well known outcome were evaluated. Outcome variables included preeclampsia, intrauterine growth retardation, placental abruption, intrauterine / early neonatal death and preterm delivery before 28 respectively 32 completed gestational weeks. Results: Best performance was reached by the use of a combination of impedance and presence of notch (no notch and mean PI>P95 or unilateral notch and mean PI>P90 or bilateral notch and mean PI>P50). With this method, the sensitivity for preeclampsia was 54.91% with a specificity of 93.4%, the sensitivity for placental abruption was 42.3% with a specificity of 93.2%, the sensitivity for preterm delivery <32 completed gestational weeks was 41.5% with a specificity of 93.5%, the sensitivity for delivery of an SGA-fetus was 31.2% with a specificity of 94.0%. Uni- or bilateral notching alone, elevated impedance alone and another combination of notching and elevated impedance (no notch and mean PI>P90, unilateral notch and mean PI>P50 or bilateral notch in combination with any impedance) performed worse. Conclusion: Best results of DSUA are reached using an appropriate definition of pathological waveform which combines presence of notch and elevated impedance. Preconditions are adequate time of assessment and adequate definition of outcome variables. Our data support the hypothesis that under these circumstances, DSUA as primary screening test even in a "low-risk obstetric population" seems to be a useful tool to identify a relevant part of those women who are at elevated risk for some of the major pregnancy complications.

Table of Contents Download the whole PhDthesis as a zip-tar file or as zip-File For download in PDF format click the chapter title   0. Title page and contents 1. Introduction 1 2. Patients and methods 5 2.1. Patients  5 2.2. Method of examination  10 2.3. Evalution 12 3. Results  16 4. Discussion  55 4.1. Definition of "risk pregnancies"  55 4.2. Problems of evaluation  56 4.2.1. Time of assessment  56 4.2.2. Definition and registration of outcome variables  57 4.2.2.1. Preeclampsia  57 4.2.2.2. Placental abruption  61 4.2.2.3. Intrauterine growth retardation  61 4.2.2.4.  Preterm delivery  62 4.2.2.5. Perinatal mortality  63 4.2.3. Therapeutic interventions  64 4.2.4. Definition of abnormal waveform  66 5. Summary and conclusions  68 6. References 71 Curriculum vitae 81 Acknowledgements  84

More Information:
Online available:	http://www.diss.fu-berlin.de/2001/247/indexe.html
Language of PhDThesis:	english
Keywords:	Doppler sonography, Intrauterine death, Intrauterine growth retardation, Low risk, Neonatal death, Notching, Placental abruption, Preeclampsia, Pregnancy outcome, Prenatal diagnosis, Screening, Ultrasound, Uterine artery
DNB-Sachgruppe:	33 Medizin
Date of disputation:	11-Sep-2001
PhDThesis from:	Fachbereich Humanmedizin, Freie Universität Berlin
First Referee:	Prof. Dr. med. Rolf Becker
Second Referee:	Prof. Dr. med. Klaus Vetter
Contact (Author):	hwvollert@yahoo.com
Date created:	03-Dec-2001
Date available:	06-Dec-2001

|| DARWIN|| Digitale Dissertationen || Dissertation|| German Version|| FU Berlin|| Seitenanfang ||

	Fragen und Kommentare an: darwin@inf.fu-berlin.de
© Freie Universität Berlin 1999