Published: 2016-12-15

Role of uterine artery Doppler and roll over test in prediction of pregnancy induced hypertension

Leelavathi ., Kaytri S.


Background: The objectives of the study were the role of uterine artery Doppler ultrasound and roll over test in prediction of PIH.

Methods: After assessment of inclusion and exclusion criteria  54 antenatal women of 11-13 weeks of gestation selected for study in Department of Obstetrics and Gynecology of JSS Hospital, Mysore and are subjected to transabdominal ultrasound for dating scan and screening of uterine artery Doppler ultrasound at 11-13 weeks and again rescanned at 21-24 weeks for uterine artery Doppler ultrasound and further followed up for Roll Over Test at 28-32 weeks of gestation for development of gestational hypertension, preeclampsia and eclampsia. The presence of early diastolic notch, increased pulsatility index and resistance index are considered to be a positive predictor of preeclampsia. A positive Roll Over test is an elevation of 20 mm of Hg or more in diastolic pressure when the woman rolls over from lateral decubitus to the supine position.

Results: The primary outcome was that uterine artery Doppler ultrasound alone and combined together with roll over test shows a high specificity of 96.29% for prediction of PIH than Roll over test alone (77.77%). Positive predictive value of uterine artery study (91.68%) was higher than Roll over Test alone (64.70%) and almost equal when both uterine artery and Roll over Test are taken together (91.66%).

Conclusions: From this study we concluded that uterine artery Doppler in first and second trimester is a better predictor of PIH. Combination of Roll over test and uterine artery Doppler has similar predictive value as uterine artery Doppler than Roll over test alone.


Uterine artery Doppler, Roll over test, Pregnancy induced hypertension

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Ales KL, Clarson ME. In search of the true inception cohort. J Chronic Dis. 1987;40:815-81.

Lehmann DK, Mobic WC, Miller JM Jr. The epidemiology and pathology of maternal mortality charity hospital of Louisiana in New Orleans 1965-1984. Obstet Gynaecol. 1987;69:833-40.

Ales KL, Frayer W, Hawks G. Development and validation of a multivariate predictor of mortality in very low birth weight.J Cli Epidemiol. 1988;41:1095-103.

Dutta DC. Text book of obstetrics. 3rd edition,New Central Book Agency (Pvt) Ltd., Calcutta. 1995. pp. 230-236.

ACOG. Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin, No 33, 2002.

Khong TY, De Wolf F, Robertson WB, Brosens IA. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986;93:1049-59.

Jurkovic D, Jauniaux E, Kurjak A, Hustin J, Campbell S, Nicolaides KH. Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy. Obstet Gynecol. 1991;77:365-9.

Poon LC, Staboulidou I, Maiz N, Plasencia W, Nicolaides KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler at 11-13 weeks. Ultrasound Obstet Gynecol. 2009;34(2):142-8.

Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008;32(2):138-46.

Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res. Clin Obstet Gynaecol. 2004;18:383-96.

Antsaklis A, Daskalakis G, Tzortzis E, Michalas S. The effect of gestational age and placental location on the prediction of preeclampsia by uterine artery Doppler velocimetry in low-risk nulliparous woman. Ultrasound Obstet Gynecol. 2000;16:6359.

Campbell S, Bewley S, Cohen T. Investigation of the uteroplacental circulation by Doppler ultrasound. Semin Perinatol 1987;11(4):362 -8.

Pai MV. Improved prediction of PIH and IUGR by 2 stage screening of uterine artery Doppler velocimetry. Ind J Med USG. 2001;2:64-9.

Bower S, Bewley S, Campbell S. Improved prediction of preeclampsia by 2 stage screening of the uterine arteries using the early diastolic notch and colour Doppler imaging. Obs Gyn. 1993;82(1):78-83.

Sharma S, Oberoi U, Singh S. Uterine Artery Notching on Color Doppler Ultrasound and Rollover Test in Prediction of Pregnancy Induced Hypertension. The Journal of Obstetrics and Gynecology of India. 2011;61(6):649-51.

Venkat-Raman N, Backos M, Teoh TG. Uterine artery Doppler in predicting pregnancy outcome in woman with APLS. Am College of Obs and Gyn. 2001;98(2):235-42.