Use of Placental Pulsatility Index in High-Risk Pregnancy to Predict Fetal Growth Restriction

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Natavadee Todumrong
Dhirapatara Charoenvidhya
Boonchai Uerpairojkit


Objective: The primary objective was to determine the predictive value of placental pulsatility index (PPI) in its ability to predict fetal growth restriction in singleton pregnant women at 16 – 24 weeks of gestation. The secondary objective was to evaluate PPI in predicting adverse perinatal outcomes and to compare the efficacy of PPI with conventional uterine artery pulsatility index (UtA PI) or umbilical artery pulsatility index (UA PI) alone.

Materials and Methods: A prospective observational study enrolled singleton pregnant women at 16 – 24 weeks of gestation who were at high-risk for fetal growth restriction and had prenatal care at the King Chulalongkorn Memorial Hospital between February 12, 2018, and January 28, 2019. UtA PI and UA PI were performed and calculated as PPI by transabdominal ultrasonography. Pregnancy outcomes were recorded. The optimal cut-off for PPI was derived from the receiver operating characteristic (ROC) curve to calculate the predictive values for fetal growth restriction.

Results:  A total of 446 pregnant women were enrolled into the study. Twenty-seven cases (6%) developed fetal growth restriction. The optimal cut-off for PPI at 16 – 24 weeks of gestation was 1.38. The sensitivity, specificity, positive predictive value, and negative predictive value to predict fetal growth restriction were 66.7%, 78.8%, 16.8%, and 97.3%, respectively. The ROC curve of the PPI gave an area under the curve of 0.73 (95% confidence interval 0.61-0.84).

Conclusion: In second-trimester high-risk pregnancies, PPI had a comparable performance in predicting FGR and adverse perinatal outcomes compared to UtA PI alone.


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