Prediction of recurrent preeclampsia using first-trimester uterine artery Doppler

To evaluate the role of first-trimester uterine artery Doppler in the prediction of recurrent preeclampsia (PE).

Uterine artery pulsatility index (UtPI) was measured at 11 to 13 weeks' gestation in 1,810 women with singleton pregnancies who had developed PE in a previous pregnancy. They were categorized into three subgroups according to UtPI multiple of median (MoM): < 1.0, 1.0 to 1.49, and ≥ 1.50 MoM. The rate of early onset PE (< 34 weeks), intermediate PE (34 to 36 weeks), late PE (≥ 37 weeks), perinatal death, and small-for-gestational-age outcome (SGA; below the 5th percentile) were compared between each subgroup.

The median mean UtPI decreased with advancing crown-rump length (CRL) from 1.77 at CRL of 45 to 54 mm to 1.52 at CRL of 75 to 84 mm. UtPI < 1.0 MoM was associated with a low-risk of early PE (0.2%), intermediate PE (0.3%), perinatal death (0.3%), and SGA (3.3%). The risk for these complications increases with UtPI of 1.0 to 1.4 MoM or ≥ 1.5 MoM (early PE 2.8 and 14.3%, respectively, p < 0.001; intermediate PE 2.1 and 5.4%, p < 0.001; perinatal death 1.3 and 6.8%, p < 0.001; and SGA 8.0 and 20.9%, p < 0.001).

In women with previous PE, first-trimester UtPI discriminates women at high and low risk for recurrence of PE and adverse pregnancy outcomes.