Maternal History and Uterine Artery Doppler in the Assessment of Risk for Development of Early- and Late-Onset Preeclampsia and Intrauterine Growth Restriction

Abstract

Objective. To examine the value of one-step uterine artery Doppler at 20 weeks of gestation in the prediction pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). Methods. A prospective multicentre study that included all women with singleton pregnancies at 19–22 weeks of gestation (w). The mean pulsatility index (mPI) of both uterine arteries was calculated. Receiver-operating characteristics curves (ROC) were drawn to compare uterine artery Doppler and maternal risk factors for the prediction of early-onset PE and/or IUGR (before 32 w) and late-onset PE and/or IUGR. Results. 6,586 women were included in the study. Complete outcome data was recorded for 6,035 of these women (91.6%). PE developed in 75 (1.2%) and IUGR in 69 (1.1%) cases. Uterine Doppler mPI was 0.99 and the 90th centile was 1.40. For 10% false-positive rate, uterine Doppler mPI identified 70.6% of pregnancies that subsequently developed early-onset PE and 73.3% of pregnancies that developed early-onset IUGR. The test had a lower detection rate for the late-onset forms of the disease (23.5% for PE and 30% for IUGR). Maternal history has a low sensitivity in the detection of early-onset cases, although it is better at detecting late-onset PE. Conclusion. Uterine artery Doppler and maternal risk factors seem to select two different populations - early and late-onset PE which might suggest a different pathogenesis.

Added Value of Angiogenic Factors for the Prediction of Early and Late Preeclampsia in the First Trimester of Pregnancy

“…Concerning sFlt-1, although second- and third-trimester levels before the onset of PE have been consistently reported to be higher [11,16,21], findings in first-trimester patients are conflicting. Several studies reported similar sFlt-1 values between cases and controls, either when overall PE was used as main outcome measure [16,22,23,24,25,26] or when patients were grouped as early- and late-onset disease [27].…”

“…The sensitivity of algorithms based on baseline and biophysical factors has been reported to be lower in populations with low cardiovascular risk [9,11,20] in comparison with higher-risk pregnant populations. Angiogenic factors represent the most accurate maternal biomarkers characterizing the presence of PE, as they are a direct reflection of the pathophysiological placental and endothelial processes involved in the disease.…”

“…Currently, efforts are aimed at combining maternal characteristics and biophysical and biochemical markers assessed in the first trimester into multivariate algorithms so that the risk of PE can be estimated with performance levels that could reach clinical utility [7,8,9]. In addition, it has become accepted that early- and late-onset PE require different predictive algorithms, due to the relevant differences in the degree and type of placental disease and maternal predisposition in these two clinical forms [1,8,9,10,11]. …”

Value of PI of uterine artery at 23-24 weeks in the prediction of adverse pregnancy outcome

“…Similar values have been obtained in some of the previous studies. [22][23][24] There was no association between uterine artery PI >95 th percentile and spontaneous preterm delivery in the present study. Similar results have been obtained in previous study.…”

Oxidative stress in the fetus of preeclamptic women with fetal growth restriction

“…We also found that HIF-1α and 8-OHdG staining in preeclamptic women with FGR was stronger than in preeclamptic women without FGR. 5,18,19) Furthermore, almost all preeclamptic women with FGR had early-onset preeclampsia, and almost all preeclamptic women without FGR had late-onset preeclampsia. The mean PI in early-onset preeclamptic women was significantly greater than in late-onset preeclamptic women.…”