First-Trimester Uterine Artery Doppler Analysis in the Prediction of Later Pregnancy Complications

Abstract

Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

Association between fetal fraction at the second trimester and subsequent spontaneous preterm birth

“…In these pregnancies, impaired invasion of the deeper myometrial segments of the spiral arteries and incomplete remodeling of uterine spiral artery endothelial cells may occur during the early and middle stages of pregnancy. This will lead to poor placental perfusion, placental ischemia and hypoxia, further resulting in an increased apoptosis and necrosis of trophoblast cells, and an increase in the release of cff‐DNA . Moreover, there are other pathological processes implicated in the SPTB without inflammation, such as uterine overdistension, cervical insufficiency, and others, which may not necessarily involve vascular lesions in the placenta.…”

Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

“…Poor placentation is associated with an imbalance of circulating vasoactive factors and, in turn, leads to maternal vascular maladaptation with associated systemic endothelial dysfunction. 5,6 Placental products are released as part of the placentation process. Levels of these biochemical markers reflect the pathophysiology of defective placentation, and, as a consequence, are assuming an increasing role in early gestation screening tests for later pregnancy complications.…”

Prediction and prevention of pre‐eclampsia in Asian subpopulation

“…Prediastolic notching and elevated pulsatility index of uterine artery (UtAPI) in the first trimester predict early‐onset pre‐eclampsia better than all other types of pre‐eclampsia (DR 47.8% and 26.4%, respectively) . The UtAPI in low‐risk populations yields moderate sensitivity (34–76%) and specificity (83–93%) . It is not predictive until week 11 as recent data indicate that trophoblast plugs block the spiral arteries until 11 weeks of gestation .…”