Uterine artery Doppler screening for adverse pregnancy outcome

PURPOSE OF REVIEW: This article reviews publications in the area of uterine artery Doppler screening that were published during the past year. RECENT FINDINGS: Studies have shown that assessment of a woman's level of risk for pre-eclampsia by uterine artery Doppler performs better than maternal history alone. Combination of maternal history and uterine artery Doppler findings leads to even more accurate assessment of risk, and allows calculation of patient-specific risk. Combining screening with uterine artery Doppler and maternal serum biochemical markers has been explored in some studies, but data remain limited and larger prospective longitudinal studies are needed to asses the effectiveness of these techniques. A number of promising markers for development of the disease have been identified, however, including pregnancy associated plasma protein-A, inhibin-A, activin-A and fibronectin, as well as placental growth factor, vascular endothelial growth factor and soluble fms-like tyrosine kinase 1. SUMMARY: Uterine artery Doppler has proved useful in identifying women at high and low risk for developing complications of uteroplacental insufficiency and may aid in stratifying antenatal care. In addition, it can identify women in whom biochemical markers should be measured in order to develop screening tests and aid in evaluation of the pathophysiology of impaired placentation and pre-eclampsia. Whether pharmacological intervention in women identified to be at high risk for pre-eclampsia on the basis of Doppler is effective in reducing the incidence of the disease remains to be established.