First-Trimester Uterine Artery Doppler for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndrome Study

Abstract

Preeclampsia (PE) is a multisystem disorder of pregnancy defined by the combination of new-onset hypertension and proteinuria that contribute substantially to perinatal morbidity and mortality worldwide. 1,2 The etiology of PE remains controversial but it is now recognized that alterations in the growth and development of placental villi and their underlying vasculature play an important role in the pathogenesis of the disease. 3 The physiological transformation of uterine spiral arteries by the cytotrophoblast invading the myometrium is typically altered in the preterm forms of pre-eclampsia. 4,5 Recent evidences suggest that low-dose aspirin started before 16 weeks of gestation can prevent preterm pre-eclampsia. 6-10 Currently, low-dose aspirin is recommended in high-risk women based on previous pregnancy complications or other risk factors such as chronic hypertension. However, most cases of pre-eclampsia occur in nulliparous women without such risk factors.Uterine artery (UtA) pulsatility index (PI) measured by Doppler's ultrasound allows an indirect measure of placental vascular resistance which is usually increased in cases of Keywords AbstractObjective This study aimed to estimate the performance of first-trimester uterine artery (UtA) pulsatility index (PI) for the prediction of preeclampsia (PE). Study Design We conducted a prospective cohort study of nulliparous women with singleton gestation at 11 to 13 6/7 weeks. UtA-Doppler's was performed on both UtAs and the mean UtA-PI was reported in multiple of median (MoM) adjusted for gestational age. Using receiver operating characteristic curves and their area under the curves (AUC); we calculated the performance of UtA-PI for the prediction of PE. Proportional hazard models were used to develop prediction models combining UtA-PI and maternal characteristics. Results Out of 4,676 participants with completed follow-up, 232 (4.9%) developed PE, including 202 (4.3%) term and 30 (0.6%) preterm PE. Mean UtA-PI decreased with gestational age between 11 and 13 6/7 weeks (p < 0.001). First-trimester UtA-PI was associated with preterm (AUC: 0.69; 95% CI [confidence interval]: 0.57-0.80) but not with term (AUC: 0.52; 95% CI: 0.48-0.56) PE. UtA-PI combined with maternal characteristics could predict 45% of preterm PE at a false positive rate of 10%. Conclusion First-trimester UtA-PI decreases with gestational age between 11 and 13 6/7 weeks and is associated with the risk of preterm but not term PE.

Screening of High-Risk Patient by Uterine Artery Doppler Analysis in The 1st Trimester to Predict Early Onset Pre-Eclampsia

“…As regards BMI, our results were in agreement with the study of Demers et al (13) , as they reported significant difference between both groups in the BMI values. However, Liu et al (14) reported that age showed significant difference among eclampsia cases and controls.…”

Combination of three‐dimensional placental vascular indices and volume and uterine artery pulsatility index at 10–13 weeks of gestation could improve the prediction of adverse pregnancy outcomes

“…High UtA‐PI in the second and third trimesters of pregnancy is related to the risk of preeclampsia and SGA 3 . In the first trimester, the accuracy of UtA‐PI for prediction of preeclampsia is reportedly controversial 4–8 . Demers et al 5 and Melchiorre et al 4 reported that the first trimester UtA‐PI was associated with the risk of preterm preeclampsia but not with the risk of term preeclampsia.…”

“…In the first trimester, the accuracy of UtA‐PI for prediction of preeclampsia is reportedly controversial 4–8 . Demers et al 5 and Melchiorre et al 4 reported that the first trimester UtA‐PI was associated with the risk of preterm preeclampsia but not with the risk of term preeclampsia. Since UtA‐PI cannot assess the placental circulation in real time, it seems to show significant changes only after at least two‐thirds of the placental vascularization is affected 25 .…”

“…Therefore, early identification of pregnancies at risk to develop these complications is very critical. Several studies have developed first trimester screening models using biochemical markers including pregnancy‐associated plasma protein A (PAPP‐A), free beta‐human chorionic gonadotropin (β‐hCG), and sonographic indices such as uterine artery pulsatility index (UtA‐PI) and shown varying results 1–8 …”

Predictive Value of both Serum Placental protein 13 Level and Uterine Artery Doppler for Prediction of Pre-Eclampsia

“…Also, our study found that uterine artery PI could predict PE at a sensitivity and specificity of 81.3 % and 72.2 %. However, in the study of Demers et al [20] , first-trimester uterine artery [UtA] pulsatility index [PI] was associated with preterm but not with term PE. However, in the study of Myatt et al [21] , uterine artery Doppler measurements prior to 21 weeks of gestation [median 16.6 weeks] showed low (poor) sensitivity for prediction of preeclampsia overall in a well-characterized, low-risk, nulliparous females.…”