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Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre‐eclampsia
Author(s) -
Herraiz I.,
Escribano D.,
GómezArriaga P. I.,
HerníndezGarcía J. M.,
Herraiz M. A.,
Galindo A.
Publication year - 2012
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.10147
Subject(s) - medicine , obstetrics , population , eclampsia , percentile , odds ratio , uterine artery , body mass index , gestation , gynecology , pregnancy , statistics , genetics , mathematics , environmental health , biology
Objective To evaluate the performance of models described previously for the prediction of pre‐eclampsia (PE), based on the sequential evaluation of uterine artery resistance at 11–13 weeks and 19–22 weeks, in a high‐risk population. Methods This was a prospective study in 135 women with singleton pregnancies and at least one of the following high‐risk conditions: PE and/or intrauterine growth restriction in a previous pregnancy, chronic hypertension, pregestational diabetes, renal disease, body mass index > 30 kg/m 2 , autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome or rheumatoid arthritis) and thrombophilia. Mean uterine artery pulsatility index (mUtA‐PI) at 11–13 and at 19–22 weeks' gestation was measured and analyzed according to quantitative and semi‐quantitative models, to predict late PE (resulting in delivery ≥ 34 weeks) and early PE (delivery < 34 weeks). Results Late PE developed in 21 (15.6%) pregnancies and early PE in six (4.4%). Using mUtA‐PI, the detection rates of late and early PE for a false‐positive rate of 10% were 14.3% and 33.3%, respectively, at 11–13 weeks, and 19.0% and 66.7%, respectively, at 19–22 weeks. Using a semi‐quantitative approach, the group of pregnant women with mUtA‐PI ≥ 90 th percentile at both 11–13 and 19–22 weeks had a greater risk for early PE (odds ratio, 21.4 (95% CI, 2.5–184.7)) compared with the group with mUtA‐PI < 90 th percentile at both periods. Using a quantitative approach, there was relative worsening in the mUtA‐PI (multiples of the median) from the first to the second trimester in all cases of early PE. Conclusion The application of semi‐quantitative and especially quantitative models to evaluate sequential changes in uterine artery Doppler findings between the first and second trimesters could be of additional value in assessing high‐risk women regarding their true risk of developing early PE. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.