First trimester Doppler velocimetry of the uterine artery ipsilateral to the placenta improves ability to predict early-onset preeclampsia

Abstract

This study sought to investigate the effects of placental laterality on the measurements of uterine artery (UtA) Doppler velocimetry and their application in predicting early-onset preeclampsia (PE). We conducted a prospective cohort study on all women with singleton, uncomplicated pregnancies scheduled for first-trimester nuchal translucency at our institution. Pulsatility index (PI) for both UtAs was measured by Doppler velocimetry, and placental laterality was determined. Additionally, pregnancy outcome data were abstracted from the medical records. Receiver operating characteristic curves (ROCs) were plotted. Of the 304 patients enrolled, 247 met the inclusion criteria. Among these patients, 240 had uncomplicated delivery, while 7 had early delivery at <34 weeks due to PE. For the uncomplicated pregnancies, PI measurements of the UtA ipsilateral to the placenta were similar (left versus right UtA: 1.06 ± 0.38 vs. 1.04 ± 0.40; P = .745). However, PI measurements of the UtA contralateral to the placenta differed significantly (left versus right UtA: 1.45 ± 0.51 vs. 1.3 ± 0.47; P = .027). In predicting early-onset PE, the ideal cut-off value for the placental side PI was 1.91, with sensitivity 100% and specificity 96.3%. For nonplacental side PI, the ideal cut-off value for PI was 1.975, with sensitivity 57.1% and specificity 79.2%. Using the mean of the left and right UtA PI, the ideal cut-off value was 1.63, with sensitivity 100% and specificity 74.2%. ROC analysis confirmed that PI measurements of the UtA on the placental side were significantly lower than those on the contralateral side, PI measurements of the UtA ipsilateral to the placenta were similar.

B‐flow/spatiotemporal image correlation M‐mode: novel ultrasound method that detects decrease in spiral artery luminal diameter in first trimester in primate model of impaired spiral artery remodeling

“…However, an in-vivo assessment tool that can reliably quantify impaired SAR has not been developed. Although uterine artery flow resistance is currently used as a proxy marker for impaired placentation, its value in the first and second trimesters as a standalone test is limited [4][5][6] . Histological studies show clearly that extensively remodeled spiral arteries have a thin wall that accommodates increased blood flow, whereas poorly remodeled vessels retain a thickened wall and narrow lumen 7 .…”

A Review of Roles of Uterine Artery Doppler in Pregnancy Complications

“…If maternal body mass index (BMI) is too high, the uterine artery PI (UtA-PI) will be less ( 1 ). Besides, UtA-PI of the placental side is lower than that of the non-placental side ( 24 ).…”

“…If maternal body mass index (BMI) is too high, the uterine artery PI (UtA-PI) will be less (1). Besides, UtA-PI of the placental side is lower than that of the non-placental side (24). "Notching" is a relatively common characteristic that appears during the early stages of 46-64% of normal pregnancies (1).…”

Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women

“…Studies have reported that placenta localization is effective in uterine artery Doppler, and there is an increase in the uterine artery Doppler PI of the contralateral side of the placenta. 41,42 Oloyede and Iketubosin reported that left uterine artery Doppler values were higher than right uterine artery Doppler values in normal pregnancies. They also stated that this increase was evident in patients with placental disorders.…”