Uterine artery Doppler at 11-14 weeks of gestation in the prediction of preeclampsia: An observational study.

Abstract

Background: Pre-eclampsia is a significant challenge in obstetric care and adversely affects the feto-maternal outcomes, causing significant perinatal morbidity and mortality. Early detection of women at higher risk of developing pre-eclampsia in the first trimester provides a vital opportunity to initiate timely prophylactic therapies. First-trimester uterine artery Doppler is gaining prominence as a promising tool in early risk stratification.

Aim: To assess the role of uterine artery Doppler in screening for pre-eclampsia at 11-14 weeks of gestation.

Methods: Pregnant women attending routine antenatal care between 11 weeks and 14 weeks of gestation and undergoing first-trimester nuchal translucency screening were offered enrolment in the study. After calculating gestational age from the last menstrual period or fetal biometry (crown-rump length), Doppler ultrasound of bilateral uterine arteries was performed, and relevant Doppler parameters were recorded. Patients were followed until delivery for development of preeclampsia.

Results: Out of a total of 342 participants, 42 women (12.28%) developed preeclampsia, while the remaining 300 women (87.71%) had a normal pregnancy without preeclampsia. The mean uterine artery pulsatility index was significantly elevated in the pre-eclampsia group (1.9455 ± 0.36) compared to the normal group (1.474 ± 0.52) (P < 0.001). Using a pulsatility index threshold of 1.622, the receiver operating characteristic curve analysis demonstrated a sensitivity of 75% (95% confidence internal: 0.66-0.82), specificity of 86% (95% confidence internal: 0.78-0.91), positive predictive value of 84.27%, and negative predictive value of 77.48% with a diagnostic accuracy of 80.5%. The area under the curve was 0.896, indicating good diagnostic performance. Uterine artery notching was observed in 88% of the pre-eclampsia group compared to 16% in the control group, a difference that was statistically significant (P < 0.001).

Conclusion: Uterine artery Doppler in the first trimester at 11-14 weeks of gestation showed a good diagnostic value for forecasting the development of pre-eclampsia and holds promise as a valuable tool for early risk stratification.