Comparison of Doppler studies in obstetrics with foetal outcome.

OBJECTIVE To compare umbilical and middle cerebral artery Doppler ultrasound values in high and low risk pregnancies withfoetal outcome. DESIGN Descriptive prospective study. SETTING Aga Khan University Hospital, Nairobi between the months of February and November 2007. SUBJECTS One hundread and twenty one consecutive female subjects, between 24 and 443 years of age, at or over 28 weeks gestation, referred to the Radiology Department of Aga Khan University Hospital for obstetric Doppler ultrasonography. MAIN OUTCOME MEASURES Foetal outcome was defined as poor by using either APCAR score (below eight out of ten at five minutes), weight, head circumference and length below tenth percentile for gestation at delivery or by mortality. RESULTS Outcome was available for 100 of the 121 patients. Twenty six percent of pregnancies had poor outcome. Of these 73% (19) and 27% (7) were classified as high risk and low risk respectively. Accuracy for umbilical artery Doppler in predicting foetal outcome was 80.8 and 82.9% for high and low risk pregnancies respectively. Accuracy for middle cerebral artery Doppler was 71.2% and 97.6% for high and low risk pregnancies respectively. Overall, accuracy for umbilical artery and middle cerebral artery Doppler in predicting foetal outcome was 76 and 82% respectively. Umbilical artery alone or in combination with middle cerebral artery Doppler was shown to have 100% specificity for predicting foetal outcome. However, sensitivities and negative predictive values were poor, ranging from 8-21% and 17-35% respectively. Middle cerebral artery specificities were lower at 80 and 85% for high and low risk pregnancies respectively. CONCLUSION Umbilical and middle cerebral artery Doppler values in pregnancy are fair predictors of foetal outcome. However, these Doppler indices are useful in pregnancy to exclude foetal compromise.