Uterine artery Doppler analysis at 11-14 weeks as a predictor of intra-uterine growth restriction


  • Uttara Gupta Department of Obstetrics and Gyanecology, People’s College of Medical Science and Research Centre, Bhopal, Madhya Pradesh, India
  • Usha Agrawal Department of Obstetrics and Gyanecology, People’s College of Medical Science and Research Centre, Bhopal, Madhya Pradesh, India




Uterine artery Doppler, IUGR, Pulsatility index, Resistance index


Background: Successful pregnancy results from reciprocity between placental and maternal cardiovascular system. Intra-uterine growth restriction (IUGR) is a condition which arises from insufficiency of placenta and can be seen as variations in waveforms in uterine artery (UtA). In our study, we studied, whether predictive accuracy of various UtA Doppler indices for IUGR in first trimester early enough to provide an intervention for prevention of IUGR, as it was a leading cause of neonatal morbidity and mortality.

Methods: The study design was a prospective observational study. UtA Doppler was done at 11-14 weeks in 120 pregnancies attending the outpatient and inpatient department of obstetrics and gynaecology, PCMS, Bhopal. The left and right UtA velocity waveforms were studied. Mean pulsatility index (PI), mean resistive index (RI) and diastolic notch were noted. Results obtained were analyzed and tabulated.

Results: Amongst these, 25.86% developed IUGR. First trimester UtA mean RI and PI were remarkably elevated in patients who developed IUGR on follow up. No relationship was noted between diastolic notch and IUGR. Mean RI and PI were found to be good predictors of IUGR. Using receiver operating characteristics (ROC) curve, the best cut-off of mean RI and mean PI to detect IUGR was 0.68 and 1.56 respectively.

Conclusions: UtA Doppler at 11-14 weeks of gestation recognizes a huge proportion of women who will develop IUGR.



Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-99.

Khan KS, Wojdyla D, Say L, Gulmezoqlu AM, VanLook PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74.

Walker JJ. Pre-eclampsia. Lancet. 2000;356(9237):1260-5.

Khong TY, DeWolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by preeclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986;93(10):1049-59.

Pijnenborg R, Anthony J, Davey DA, Rees A, Tiltman A, Vercruysse L, et al. Placental bed spiral arteries in the hypertensive disorders of pregnancy. Br J Obstet Gynaecol. 1991;98(7):648-55.

Shanklin DR, Sibai BM. Ultrastructural aspects of pre-eclampsia I: Placental bed and boundary vessels. Am J Obstet Gynecol. 1989;161(3):735-41.

Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta. 1983;4(4):397-413.

Kam EPY, Gardner L, Loke YW, King A. The role of trophoblast in the physiological change in decidual spiral arteries. Hum Reprod. 1999;14(8):2131-8.

Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003;69(1):1-7.

Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of preeclampsia and intrauterine growth retardation. BJOG. 1993;100(11):989-94.

Irion O, Masse J, Forest JC, Moutquin JM. Prediction of preeclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women. BJOG. 1998;105(4):422-9.

Albaiges G, Missfelder-Lobos H, Parra M, Lees C, Cooper D, Nicolaides KH. Comparison of color Doppler uterine artery indices in a population at high risk for adverse outcome at 24 weeks’ gestation. Ultrasound Obstet Gynecol. 2003;21(2):170-3.

North RA, Ferrier C, Long D, Townsend K, Kincaid-Smith P. Uterine artery Doppler flow velocity waveforms in the second trimester for the prediction of pre-eclampsia and fetal growth retardation. Obstet Gynecol. 1994;83(3):378-86.

Papagerghiou AT, Yu CK, Bindra R, Pandis G, Nicolaides KH. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18(5):441-9.

Caniggia I, Winter J, Lye SJ, Post M. Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia. Placenta. 2000;21:25-30.

Campbell S, Griffin DR, Pearce JM, Recasens TE Cohen-Overbeek, Wilson K, et al. New Doppler technique for assessing uteroplacental blood flow. Lancet. 1983;26:675-7.

Trudinger BJ, Giles WB, Cook CM. Uteroplacental blood flow velocity – time waveforms in normal and complicated pregnancy. Br J Obstet and Gynecol. 1985;92:39-45.

Ducey J. Complication of hypertension in pregnancy based on Doppler velocimetry. Am. J Obstet Gynecol. 1987;157(3):680-5.

Gomez O, Martinez JM, Figueras F, DelRio M, Borobio V, Puerto B, et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol. 2005;26(5):490-4.

Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11–14 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18(6):583-6.

Dugoff L, Lunch AM, Cioffi-Ragan D, Hobbins JC, Schultz LK, Malone FD, D’Alton ME, for the FASTER Trial Research Consortium. Am J Obstet Gynecol. 2005;193:1208-12.

Melchiorre K, Leslie K, Prefumo F, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction. Ultrasound Obstet Gynecol. 2009;33(5):524-9.






Original Research Articles