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June 28, 2026
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Abstract

Uterine artery Doppler velocimetry has been widely adopted as a non-invasive tool to evaluate uteroplacental hemodynamics and is already used clinically, particularly in first-trimester preeclampsia screening, second-trimester risk stratification for adverse pregnancy outcomes, infertility assessment and monitoring of twin pregnancies. This systematic review combines evidence from 31 empirically validated studies until 2026. Longitudinal cohort study of 476 low-risk pregnancies [1] established normative uterine artery pulsatility index reference ranges highlighting progressive decline from first to third trimester. Uterine artery pulsatility index was shown to have a meta-analysis of 81,673 patients moderate sensitivity of 0.586 and high specificity at 0.879 for predicting preeclampsia [2]. In fact, research undertaken in the field of unexplained infertility showed that there are strikingly higher levels of uterine artery pulsatility index in women with unexplained infertility compared to fertile controls [3]. In a prospective longitudinal study of 538 women, they found that history of previous Cesarean delivery does not have independent effect on uterine artery Doppler values through pregnancy[4]; Sex differences between fetuses in uterine artery Doppler [5] were identified, with a more rapid deterioration of uteroplacental perfusion and associated greater incidence of fetal compromise higher in male fetuses than female fetuses in complicated pregnancies. Randomized controlled trials of aspirin prophylaxis in high-risk women defined by Doppler imaging have shown mixed results with one trial showing benefit and another showing no effect on the incidence of preeclampsia [6,7]. In a prospective study of 106 patients, uterine artery pulsatility index > the 95th centile was strongly associated with preeclampsia and small for gestational age whereas isolated diastolic notch showed no significant association [8]. With this review, we aim to offer evidence-based clinical guidelines on the incorporation of uterine artery Doppler into clinical practice.The purpose of this systematic review was to determine if reference ranges established for the assessment of uterine artery Doppler parameters can be extrapolated into groups not used for their establishment

Keywords

uterine artery Doppler pulsatility index preeclampsia screening reference ranges unexplained infertility aspirin prophylaxis fetal growth restriction twin pregnancy

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Copyright (c) 2026 Riyadh Adel Jaed Abdulazeez, Firas Abdullah Noori Al Baghdadi

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