Screening for pre-eclampsia by using changes in uterine artery Doppler indices with advancing gestation

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Cardiovascular Physiology in Pregnancy

Background:

• Pre-eclampsia (PE) is a major cause of maternal and fetal morbidity.
• Early identification of PE risk is crucial for timely intervention.
• Uterine artery (UtA) Doppler pulsatility index (PI) is a non-invasive marker used in pregnancy surveillance.

Purpose of the Study:

• To evaluate the association between changes in UtA Doppler PI from the first to the second trimester and the development of PE.
• To identify the most effective index for predicting early and preterm PE based on UtA Doppler PI variations.

Main Methods:

• Retrospective analysis of singleton pregnancies with UtA Doppler screening in both first and second trimesters (2002-2009).
• Calculation of multiples of median for UtA Doppler PI to derive indices of UtA changes.
• Utilized receiver-operating characteristics (ROC) curves to assess predictive performance.

Main Results:

• 3549 women were included; 126 developed PE (22 early PE, 41 preterm PE).
• The difference between mean second and first trimester UtA PI showed the highest predictive value.
• ROC analysis yielded areas of 0.851 for early PE and 0.786 for preterm PE.

Conclusions:

• Changes in UtA resistance, quantified by the difference in mean PI between trimesters, are significant predictors of PE.
• The calculated difference in mean UtA PI is the optimal index for predicting early and preterm pre-eclampsia.