Uterine artery Doppler at 11-14 weeks of gestation in the prediction of preeclampsia: An observational study

Abstract

BACKGROUND

Pre-eclampsia is a significant challenge in obstetric care and adversely affects the feto-maternal outcomes, causing significant perinatal morbidity and mortality. Early detection of women at higher risk of developing pre-eclampsia in the first trimester provides a vital opportunity to initiate timely prophylactic therapies. First-trimester uterine artery Doppler is gaining prominence as a promising tool in early risk stratification.

AIM

To assess the role of uterine artery Doppler in screening for pre-eclampsia at 11-14 weeks of gestation.

METHODS

Pregnant women attending routine antenatal care between 11 weeks and 14 weeks of gestation and undergoing first-trimester nuchal translucency screening were offered enrolment in the study. After calculating gestational age from the last menstrual period or fetal biometry (crown-rump length), Doppler ultrasound of bilateral uterine arteries was performed, and relevant Doppler parameters were recorded. Patients were followed until delivery for development of preeclampsia.

RESULTS

Out of a total of 342 participants, 42 women (12.28%) developed preeclampsia, while the remaining 300 women (87.71%) had a normal pregnancy without preeclampsia. The mean uterine artery pulsatility index was significantly elevated in the pre-eclampsia group (1.9455 ± 0.36) compared to the normal group (1.474 ± 0.52) (P < 0.001). Using a pulsatility index threshold of 1.622, the receiver operating characteristic curve analysis demonstrated a sensitivity of 75% (95% confidence internal: 0.66-0.82), specificity of 86% (95% confidence internal: 0.78-0.91), positive predictive value of 84.27%, and negative predictive value of 77.48% with a diagnostic accuracy of 80.5%. The area under the curve was 0.896, indicating good diagnostic performance. Uterine artery notching was observed in 88% of the pre-eclampsia group compared to 16% in the control group, a difference that was statistically significant (P < 0.001).

CONCLUSION

Uterine artery Doppler in the first trimester at 11-14 weeks of gestation showed a good diagnostic value for forecasting the development of pre-eclampsia and holds promise as a valuable tool for early risk stratification.

Keywords: Pre-eclampsia; Uterine artery Doppler; First trimester; Pulsatility index; Resistive index; Diastolic notch

Core Tip: In this observational study, we examined the role of uterine artery Doppler assessment in the first trimester between 11 weeks and 14 weeks of gestation in predicting the development of preeclampsia. Our findings suggest that abnormal uterine artery Doppler parameters at 11-14 weeks of gestation are significantly associated with an elevated risk of developing preeclampsia later in pregnancy. Using receiver operating characteristic curve analysis, we demonstrate that, at specific cut-off values for the pulsatility index and resistive index, uterine artery Doppler shows good discriminatory power in predicting the future risk of preeclampsia.