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First‐trimester uterine artery Doppler indices in term and preterm pre‐eclampsia
Author(s) -
Melchiorre K.,
Wormald B.,
Leslie K.,
Bhide A.,
Thilaganathan B.
Publication year - 2008
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.5400
Subject(s) - medicine , eclampsia , uterine artery , obstetrics , pregnancy , spiral artery , prospective cohort study , gynecology , gestation , fetus , placenta , genetics , biology
Objectives To assess the relationship between first‐trimester uterine artery Doppler measurements and the development of term and preterm pre‐eclampsia. Methods This prospective study of uterine artery Doppler findings at 11–14 weeks in 3058 singleton pregnancies included 57 and 33 cases of term and preterm pre‐eclampsia, respectively. Results The first‐trimester uterine artery resistance index (RI) was significantly higher in women who subsequently developed preterm pre‐eclampsia (mean RI, 0.79) than in those with a normal outcome (mean RI, 0.70; P = 0.0001) or those who developed pre‐eclampsia at term (mean RI, 0.72; P = 0.002). There were no significant differences in first‐trimester mean uterine artery RI ( P = 0.136) or prevalence of bilateral notches ( P = 0.459) between women who had a normal pregnancy outcome and those who developed pre‐eclampsia at term. The receiver–operating characteristics curves for the prediction of term and preterm pre‐eclampsia by uterine artery Doppler imaging demonstrated a significant association with development of preterm pre‐eclampsia ( P = 0.0001; area under the curve (AUC), 0.76; 95% CI, 0.66–0.86) but not term pre‐eclampsia ( P = 0.25; AUC, 0.54; 95% CI, 0.46–0.63). Conclusions The uterine artery Doppler data in this study suggest that preterm pre‐eclampsia is strongly associated with defective invasion of the spiral arteries, in contrast to the findings in term pre‐eclampsia which may be a consequence of placental deterioration at term. Our study findings support, but do not prove, a rigid separation between the etiology of early‐ and late‐onset pre‐eclampsia. Although there is a strong relationship between first‐trimester uterine artery Doppler indices and the subsequent development of preterm pre‐eclampsia, our data do not support its routine introduction into clinical practice. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.