Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia

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 1113 weeks and 1922 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/m2, autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome or rheumatoid arthritis) and thrombophilia. Mean uterine artery pulsatility index (mUtA-PI) at 1113 and at 1922 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 1113 weeks, and 19.0% and 66.7%, respectively, at 1922 weeks. Using a semi-quantitative approach, the group of pregnant women with mUtA-PI = 90th percentile at both 1113 and 1922 weeks had a greater risk for early PE (odds ratio, 21.4 (95% CI, 2.5184.7)) compared with the group with mUtA-PI < 90th 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 (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd.