Abstract: Objective: To evaluate the predictive level for fetal growth restriction (FGR) at 11-13⁺⁶ weeks of gestation by uterine artery Doppler or/and level of PAPP-A. Methods: A prospective study was performed on 2 000 singleton pregnancies attending routine care at 11-13⁺⁶ weeks of gestation. Uterine artery Doppler ultrasound was performed and maternal serum pregnancy associated plasma protein A( PAPP-A) level was assayed. The maternal and neonatal outcome were followed up. Results: ① Among the 2 000 cases,13 pregnancies were terminated for fetal abnormalities or intrauterine fetal death before 28 weeks, 76 cases developed FGR, 426 cases were proved having other adverse pregnancy outcomes, and the remaining 1 485 cases had normal outcomes. ② Compared with normal group, the mean uterine artery pulsatility index(PI)and uterine resistance index(RI)and the presence of early diastolic notch in blood flow were higher and PAPP-A level was lower in FGR group.③ In screening FGR, the combination of uterine artery PI and PAPP-A had a sensitivity of 81.6%, and the combination of uterine artery PI, PAPP-A and the presence of early diastolic notch increased the sensitivity to 82.9%, yet the difference did not reach statistical significance. Conclusions: Uterine artery PI together with PAPP-A and presence of early diastolic notch at 11-13⁺⁶ weeks could provide sensitive prediction of the development of FGR. However, the effectiveness of presence of early diastolic notch is not as good as that of uterine artery PI or maternal serum PAPP-A level in screening FGR.

Key words: Doppler, Fetal growth restriction, Uterine artery, First trimester