Uterine artery Doppler and placental volume in the first trimester in the prediction of pregnancy complications

Objective To evaluate placental volume and uterine artery Doppler in the first trimester in the prediction of pregnancies that subsequently develop pre-eclampsia, pregnancy-induced hypertension, preterm placental abruption or fetal growth restriction. Methods In 380 singleton pregnancies attending our center for nuchal translucency screening at 11-14 weeks of gestation, Doppler assessment of both uterine arteries was carried out for measurement of the pulsatility index and the mean pulsatility index of the two vessels was calculated. In addition, three-dimensional ultrasound was used to obtain images for subsequent measurement of placental volume. The 90th centile of the uterine artery mean pulsatility index and the 10th centile of the placental volume for crown-rump length (placental quotient) were calculated. These cut-offs were used for the prediction of pregnancy complications. Results Complications occurred in 36 (9.5%) of the 380 pregnancies, including 31 cases of fetal growth restriction, two of pregnancy-induced hypertension and abruption, two of pregnancy-induced hypertension, and one of abruption. The uterine artery mean pulsatility index was greater than or equal to 90th centile in 38 (10%) pregnancies and this group contained nine (25%) of those that developed complications. The placental quotient was less than or equal to 10th centile in 39 (10%) pregnancies and this group contained eight (22%) of those that developed complications. In eight (2%) pregnancies the uterine artery mean pulsatiltiy index was greater than or equal to 90th centile and the placental quotient tvas less than or equal to 10th centile and this group contained six (17%) of those that developed complications. Conclusion The combination of placental volume measurement and uterine artery Doppler in the first trimester may identify women at risk for subsequent development of pregnancy complications.