Predictive value of ophthalmic artery doppler in pre-eclampsia development
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243606Keywords:
Ophthalmic artery doppler, Uterine artery doppler, Prediction of pre-eclampsia, Mean arterial pressure pre-eclampsiaAbstract
Objective: To evaluate the predictive value of maternal ophthalmic artery Doppler parameters, both independently and in combination with uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP), in forecasting pre-eclampsia (PE) development.
Methods: This prospective observational study involved women at 19-23 weeks' gestation. Maternal demographics, medical history, ultrasound for fetal anatomy and growth, and Doppler measurements of ophthalmic artery flow velocities (PSV1, PSV2, PSV ratio) along with MAP and UtA-PI were assessed.
Results: The incidence of PE was 9.4%. Women with PE were older (35.8 vs. 32.3 years, p<0.01). Seventy-five percent developed early-onset PE. Mean UtA-PI was higher in PE cases (1.91 vs 1.27, p=0.03). UtA-PI showed good predictive value with 83.3% sensitivity and 68.7% specificity (accuracy: 76%). Ophthalmic artery parameters, particularly PSV2 (27.54 vs. 23.46, p<0.01) and PSV ratio (0.8 vs. 0.61, p<0.01), were significantly higher in PE cases. These parameters had sensitivity and specificity of 83.3%/58.3% (PSV2) and 83.3%/61.7% (PSV ratio), respectively. Combined ophthalmic artery Doppler parameters showed strong predictive value (AUC 0.832), with sensitivity 58.3%, specificity 90.4%, and accuracy 87.4%. Adding uterine and ophthalmic artery Doppler parameters increased accuracy to 91.3%. The combination of MAP, UtA-PI, and ophthalmic Doppler showed the highest accuracy (97.6%, AUC 0.969) with sensitivity 91.7% and specificity 98.3%.
Conclusion: Ophthalmic artery PSV ratio is a promising predictor for PE development, warranting further validation in larger studies.
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References
Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low-and middle-income countries: A WHO secondary analysis. PLOS ONE. 2014;9(3): e91198
Mihu D, Mihu CM, Talu S, Costin N, Ciuchina S, Malutan A. Ocular changes in preeclampsia. Oftalmologia 2008;52:16–22
Hikima MS, Adamu MY, Lawal Y, Isyaku K, Isma’il A. Changes in opthalmic artery doppler velocimetry in women with preeclampsia in Kano, Nigeria. Annals of African Medicine. 2023;22(1):5
Belfort M, Van Veen T, White GL, Kofford S, Allred J, Postma I, et al. Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre‐eclampsia. Ultrasound in Obstetrics and Gynecology. 2012;40(4):406-11.
Kalafat E, Laoreti A, Khalil A, Da Silva Costa F, Thilaganathan B. Ophthalmic artery Doppler for prediction of pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(6):731-737.
Khong S.L., Kane S.C., Brennecke S.P., da Silva Costa F. First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. Dis. Markers. 2015;2015:679-730 7.
Ridding G, Schluter PJ, Hyett JA, McLennan AC. Uterine artery pulsatility index assessment at 11-13 weeks' gestation. Fetal Diag Therapy.2014;36:299-304
Roberts JM, Lain KY: Recent insights into the pathogenesis of pre-eclampsia. Placenta 2002,23: 359–372.
Mehta B, Kumar V, Chawla S, Sachdeva S, Mahopatra D. Hypertension in pregnancy: a community-based study. Indian J Community Med. 2015;40(4):273.
Nadkarni J, Bahl J, Parekh P. Perinatal Outcome in Pregnancy Associated Hypertension. Indian Pediatrics 2001;38:174-178
Bangal VB, Giri PA, Mahajan AS. Maternal and foetal outcome in pregnancy induced hypertension: A study from rural tertiary care teaching hospital in India. Int J Biomed Res. 2011;2:595–9
Kheir A. Neonatal Outcome in Hypertensive Disorders of Pregnancy in a Tertiary Neonatal Unit in Sudan.Journal of Medicine and Medical Research. 2014;2(5):59-65
Hak J, Un-Nisa N, Gupta S. LDH Levels in Pregnancy and its Association with Severity of the Disease and Feto-maternal Outcome in Pre-eclampsia and Eclampsia. JK Sciences. 2015;17(3):110-115.
Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, et al. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China. BMC Pregnancy and Childbirth. 2017; 17:1-8.
O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, Wright A, et al. Accuracy of competing‐risks model in screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation. Ultrasound Obstet Gynecol. 2017;49(6):751-5.
Owiredu WK, Ahenkorah L, Turpin CA, Amidu N, Laing EF. Putative risk factors of pregnancy-induced hypertension among Ghanaian pregnant women. J Med Biomed Sci. 2012;1(3):62-76.
Shamsi U, Saleem S and Nishter N. Epidemiology and risk factors of pre-eclampsia: an overview of observational studies.Al Ameen J Med Sci. 2013 :6(4);292-300.
Dior UP, Laufer N, Chill HH, Granovsky-Grisaru S, Yagel S, Yaffe H, et al. Increased incidence of preeclampsia in mothers of advanced age conceiving by oocyte donation. Arch Gynecol Obstet. 2018;297(5):1293-9.
Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol. 2013;209(6):544.
Neravi A, Udayashree V. Role of uterine artery Doppler at 12 to 16 weeks of gestation in prediction of pre-eclampsia an observational study. Int J Reprod Contracept Obstet Gynecol 2018;7:3162-7.
Poon LC, Kametas NA, Valencia C, Chelemen T, Nicolaides KH. Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13 weeks. Hypertens Pregnancy. 2011;30(1):93-107.
Cattaneo P, Marchetti P, Bruno VD, Mariscalco G, Sala A. Color Doppler imaging of the ophthalmic artery during antegrade selective cerebral perfusion. Tex Heart Inst J. 2007;34(1):105-7.
Cipolla MJ, Liebeskind DS, Chan SL. The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation. J Cereb Blood Flow Metab. 2018;38(12):2129-49.
Hata T, Senoh D, Hata K, Kitao M. Ophthalmic artery velocimetry in preeclampsia. Gynecol Obstet Invest. 1995;40: 32-5.
de Oliveira CA, de Sá RA, Velarde LG, da Silva FC, doVale FA, Netto HC. Changes in ophthalmic artery Doppler indices in hypertensive disorders during pregnancy. J Ultrasound Med 2013;32:609-16.
Matias DS, Costa RF, Matias B, Gordiano L, Correia LC. Ophthalmic artery doppler velocimetric values in pregnant women at risk for preeclampsia. J Ultrasound Med. 2012;31:1659-64.
Sarno M, Wright A, Vieira N, Sapantzoglou I, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in prediction of pre‐eclampsia at 35–37 weeks' gestation. Ultrasound in Obstet Gynecol. 2020;56(5):717-24.
Sultan R, Aminuddin NA, Mahdy ZA. Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia. Front Public Health. 2022;17; 10:973271
Langenveld J, Jansen S, Van Der Post J, Wolf H, Mol BW, Ganzevoort W. Recurrence risk of a delivery before 34 weeks of pregnancy due to an early onset hypertensive disorder: a systematic review. Am J Perinatol. 2010;27(07):565-71
Ferrazzani S, Luciano R, Garofalo S, D'Andrea V, De Carolis S, De Carolis MP, et al. Neonatal outcome in hypertensive disorders of pregnancy. Early human development. 2011;30;87(6):445-9
