Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

Authors

  • Patricia Malini Pereira Department of Obstetrics and Gynaecology, Justice K. S. Hegde Medical Academy, Mangalore, Karnataka, India
  • Lakshmi Manjeera M. Department of Obstetrics and Gynaecology, Justice K. S. Hegde Medical Academy, Mangalore, Karnataka, India
  • Valerie Anithra Pereira Department of Obstetrics and Gynaecology, Justice K. S. Hegde Medical Academy, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204300

Keywords:

Diastolic notch, Pre-eclampsia, Pulsatility index, Resistance index

Abstract

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.

Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.

Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.

Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.

References

Wagner LK. Diagnosis and management of preeclampsia. Am Fam Phys. 2004;70(12):2317-24.

Hjartardoltir S, Leifsson BG, Geirsson RT, Steinthrosdottir V. Paternity change and the recurrence risk in familial hypertensive disorder in pregnancy. Hypertens Pregnancy. 2004;23(2):219-25.

Khong TY, De Wolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986;93:1049-59.

Steel SA, Pearce JM, Chamberlain G. Doppler ultrasound of the uteroplacental circulation as a screening test for severe pre-eclampsia with intra-uterine growth retardation. Eur J Obstet Gynecol Reprod Biol. 1988;28:279-87.

Huppertz B. Placental origins of preeclampsia: challenging the current hypothesis. Hypertension. 2008;51(4):970-5.

Ghosh SK, Raheja S, Tuli A, Raghunandan C, Agarwal S. Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2012;161(2):144-51.

Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part II: functional assessment (Doppler). Placenta. 2008;29(11):921-9.

Kalache KD, Dückelmann AM. Doppler in obstetrics: beyond the umbilical artery. Clin Obstet Gynecol. 2012;55(1):288-95.

Papageorghiou AT, Leslie K. Uterine artery Doppler in the prediction of adverse pregnancy outcome. Curr Opin Obstet Gynecol. 2007;19(2):103-9.

Adekanmi AJ, Roberts A, Adeyinka AO, Umeh EO, Anor F, Odo JC, et al. Normal second and third trimester uterine and umbilical Doppler indices among healthy singleton gestation Nigerian women. West Afr J Radiol. 2017;24:1-7.

Fleisher A, Schulman H, Farmakides G, Bracero L, Rochelson B, Grunfeld L, et al. Uterine artery Doppler velocimetry in pregnant women with hypertension. Am J Obstet Gynecol. 1986;154:806-13.

Sahoo BK, Shaha P, Bhairagond S, Raj VR. The role of uterine artery doppler sonography in predicting pre eclampsia at 14-20 weeks of gestation. Int J Sci Res. 2016;5(2):37-47.

Padmalatha VV, Rao PSS, Abraham S, Thomas A. Predicting pre-eclampsia and foetal growth restriction through second trimester uterine artery Doppler sonography: an Indian experience. IOSR J Dent Med Sci. 2013;12(1):21-6.

Bower S, Susan B, Campbell S. Improved prediction of pre-eclampsia by two stage screening of uterine arteries using the early diastole notch and colour Doppler imaging. Obstet Gynecol. 1993;82;78-83.

Barati M, Shahbazian N, Ahmadi L, Masihi S. Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes. J Res Med Sci. 2014;19:515-9.

Rupnawar PB, Ajith S. To assess uterine artery doppler findings at 18-22 weeks in predicting adverse pregnancy outcome. IOSR J Dent Med Sci. 2015;14(8):95-100.

Yang SW, Cho SH, Kang YS, Park SH, Sohn IS, Kwon HS, et al. Usefulness of uterine artery Doppler velocimetry as a predictor for hypertensive disorders in pregnancy in women with prehypertension before 20 weeks gestation. PLoS One. 2019;14(1):1-9.

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Published

2020-09-25

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Original Research Articles