DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213864

First trimester uterine artery Doppler screening in the prediction of adverse pregnancy outcomes

Jacqueline A. Jayson, Kavita Mandrelle, Tapasya Dhar, Subhash Singla

Abstract


Background: Uterine artery Doppler waveform has been extensively studied as a predictive marker for the later development of preeclampsia and fetal growth restriction. Therefore, uterine artery doppler has emerged as a good test for the prediction of preeclampsia, being simple to perform, reproducible and non-invasive. The present study was done to evaluate the first trimester uterine artery Doppler in the prediction of adverse pregnancy outcome.

Methods: This was a prospective cohort study for all pregnant women attending antenatal clinic during 11-14 weeks of gestation at Christian medical college and hospital, Ludhiana, during a period of 18 months. Study population of (n~270) was taken. A pre-designed case record was filled at the time of registration. After taking informed consent, these women underwent ultrasound for uterine artery Doppler pulsatility index along with nuchal translucency & nasal bone scan by transabdominal ultrasound. Patients were followed up throughout the gestation to find out the development of any adverse pregnancy outcomes (early onset preeclampsia, early onset fetal growth restriction, late onset preeclampsia, late onset fetal growth restriction, oligohydramnios, placental abruption and stillbirth).

Results: In our study, about 75% of antenatal women were found to have normal first trimester uterine artery pulsatility index and the rest 25% had abnormal pulsatility index. About 40% of women with abnormal dopplers developed complications associated to hypertensive disorders and adverse pregnancy outcomes, while 60% went on to have a normal pregnancy. It was observed that 13.2% developed gestational hypertension, 10.29% developed pulmonary embolism, 1.47% developed eclampsia, 22.05% developed oligohydramnios, 42.64% developed fetal growth restriction, 4.41 % developed placental abruption and 5.88% delivered stillbirth neonates.

Conclusions: As hypertensive disorders of pregnancy pose a great risk of maternal and fetal morbidity and mortality, an evolution of Doppler studies have proven to be beneficial. Doppler ultrasound was found to be a valuable modality in the evaluation of fetal and placental circulation as well as in the prediction of pregnancy outcomes. According to the receiver operating characteristic curve obtained in our study, sensitivity and specificity of first trimester uterine artery pulsatility index was predictive for pregnancy complications and adverse outcomes.


Keywords


Uterine artery doppler, Pulsatility index, Preeclampsia, First trimester

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References


Benigni A, Gregorini G, Frusca T. Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. N Engl J Med. 1989;321(6):357-62.

Chien P, Arnott N, Gordon A, et al. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview. Br J Obstet Gynaecol. 2000;107(2):196-208.

Albaiges G, Missfelder-Lobos H, Lees C. One- stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation. Obstet Gynecol. 2000;96(4):559-64.

Bujold E, Roberge S, Lacasse Y. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010;116(2):402-14.

Roberge S, Villa P, Nicolaides K. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012; 31(3):141-6.

Koopmans C, Bijlenga D, Groen H, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomized controlled trial. Lancet. 2009;374(9694): 979-88.

James P, Nelson-Piercy C. Management of hypertension before, during and after pregnancy. Heart. 2004;90(12):1499-504.

Hutcheon J, Lisonkova S, Joseph K. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391-403.

Khan KS, Wojdyla D, Say L. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367(9516):1066-74.

Milne F, Redman C, Walker J. The preeclampsia community guideline (PRECOG): How to screen for and detect onset of preeclampsia in the community. BMJ. 2005;330(7491):576-80.

Steegers E, Von Daldelszen P, Duvekott J, et al. Preeclampsia. Lancet. 2010;376(9741):631-44.

Kane SC, da Silva CF, Brennecke S. First trimester biomarkers in the prediction of later pregnancy complications. Biomed Res Int. 2014;2014:807196.

Everett T, Lees C. Beyond the placental bed: placental and systemic determinants of the uterine artery Doppler waveform. Placenta. 2012;33(11):893-901.

Askie L, Duley L, Henderson-Smart D. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007; 369(9575):1791-8.

Velauthar L, Plana M, Kalidindi M. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol 2014;43(5):500-7.

Plasencia W, Maiz N, Poon L, et al. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008;32(2):138-46.

Ratiu D, Hide-Moser K, Morgenstern B, et al. Doppler indices and notching assessment of uterine artery between the 19th and 22nd week of pregnancy in the prediction of pregnancy outcome. Lancet. 2019;33(6):2199-204.

Barati M, Shahbazian N, Ahmadi L. Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes. J Res Med Sci. 2014;19(6):515-9.

Gadelha-Costa A, Spara P, Costa T. Uterine arteries resistance and pulsatility indices at the first and second trimesters of normal pregnancies. Radiol Bras. 2010;43(3):161-5.

Napolitano R, Melchiorre K, Arcangeli T. Screening for pre-eclampsia by using changes in uterine artery Doppler indices with advancing gestation. Prenat Diagn. 2012;32(2):180-4.

Khong SL, Kane SC, Brennecke SP. First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. Dis Markers. 2015; 2015:679730.

Kennedy AM, Woodward PJ. A Radiologist's Guide to the Performance and Interpretation of Obstetric Doppler US. Radio graphics. 2019;39(3):893-910.

Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The international federation of gynaecology and obstetrics (FIGO) initiative on preeclampsia: A pragmatic guide for first trimester screening and prevention. Int J Gynaecology Obstet. 2019;145(1):1-3.