First- and Second-Trimester Uterine Artery Doppler and Hypertensive Disorders in Twin Pregnancies

Objective: The objective of this study is the investigation of uterine artery Doppler studies in twin pregnancies. Methods: This retrospective cohort study included 554 twin pregnancies. All women underwent measurement using the mean uterine artery pulsatility index (UTPI) in gestational weeks 11⁺⁰-13⁺⁶ and 19⁺⁰-22⁺⁶ for risk assessment regarding the occurrence of preeclampsia and adverse obstetric outcomes. Results: Out of the 554 included women, a total of 51 women (9.2%) developed preeclampsia: 12 women (2.2%) developed early preeclampsia and 39 patients (7.0%) developed late preeclampsia. Adverse pregnancy outcomes occurred in 147 women (26.5%). The optimum cut-off for the mean UTPI to predict preeclampsia was calculated for gestational weeks 11⁺⁰-13⁺⁶ (UTPI > 1.682) and 19⁺⁰-22⁺⁶ (UTPI > 1.187). Between gestational weeks 11⁺⁰ and 13⁺⁶, the risk of developing preeclampsia was approximately 1.5 times higher when the mean UTPI was above the established cut-off. The risk of early preeclampsia increased 2.5-fold, and that of adverse pregnancy outcomes increased 1.5-fold. At 19⁺⁰ to 22⁺⁶ weeks, the preeclampsia risk doubled when the mean UTPI exceeded the cut-off. The risk increased 4-fold for early preeclampsia and 1.5-fold for adverse pregnancy outcomes. Regression analyses revealed that a mean UTPI above the set cut-off at both time points was significantly associated with preeclampsia, early preeclampsia, and adverse pregnancy outcomes. Conclusions: The best prediction for early preeclampsia can be achieved using a two-tailed screening approach that combines mean UTPI measurements taken at gestational weeks 11⁺⁰-13⁺⁶ and 19⁺⁰-22⁺⁶.