Ophthalmic artery Doppler in prediction of pre‐eclampsia at 35–37 weeks' gestation

Abstract

Objectives First, to examine the potential value of maternal ophthalmic artery Doppler at 35–37 weeks' gestation in the prediction of subsequent development of pre‐eclampsia (PE), and, second, to examine the variability between repeat measurements in the same eye and variability in measurements between the two eyes. Methods This was a prospective observational study in women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history and assessment of flow velocity waveforms from the maternal ophthalmic artery. Waveforms were obtained in sequence from the right eye, left eye and again from the right and then left eye. We recorded the average of the four measurements, two from each eye, for the following four indices: first peak of systolic velocity; second peak of systolic velocity; pulsatility index; and the ratio of the second to first peak of systolic velocity (PSV ratio). The measurements of the four indices were standardized to remove the effects of maternal characteristics and elements from the medical history. The competing‐risks model was used to determine the detection rate (DR) of delivery with PE at any time and at < 3 weeks after assessment, at a 10% false‐positive rate (FPR), in screening by maternal factors alone and a combination of maternal factors and the adjusted value of each of the four ophthalmic artery indices. Results The study population of 2287 pregnancies contained 60 (2.6%) that developed PE, including 19 (0.8%) that delivered with PE at < 3 weeks after assessment. The DR, at 10% FPR, of delivery with PE at any time after assessment by maternal factors was 25.0% (95% CI, 14.7–37.9%), and this increased by 25 percentage points to 50.0% (95% CI, 36.8–63.2%) with the addition of the adjusted PSV ratio (P = 0.005); the respective values for delivery with PE at < 3 weeks after assessment were 31.6% (95% CI, 12.6–56.6%) and 57.9% (95% CI, 33.5–79.8%). The other ophthalmic artery indices did not improve the prediction provided by maternal factors alone. There was good correlation between the first and second measurements of PSV ratio from the same eye (right eye r = 0.823, left eye r = 0.840), but poorer correlation in the first and second measurements between the two eyes (first measurement r = 0.690, second measurement r = 0.682). In screening by maternal factors and PSV ratio for PE with delivery at any stage after assessment, the estimated DR, at 10% FPR, was 50.0% when the average of four measurements was used (two from each eye), 49.1% when the average of one measurement from each eye was used, 47.3% when the average of two measurements from the same eye was used, and 45.8% when only one measurement was used. Conclusions Ophthalmic artery PSV ratio at 35–37 weeks' gestation can predict subsequent delivery with PE, especially if this occurs within 3 weeks after assessment. In the assessment of ophthalmic artery Doppler, it is necessary to use the average of one measurement fr...

Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre‐eclampsia at 35–37 weeks' gestation

“…A dataset containing 10 000 unaffected pregnancies and 10 000 PE pregnancies was obtained by bootstrapping maternal characteristics and medical and pregnancy history, along with outcome, from our original dataset of 2287 records. MoM values for MAP, UtA-PI, serum PlGF and serum sFlt-1 and delta values for ophthalmic artery PSV ratio were simulated from a multivariate Gaussian distribution 16,24 . DRs for a FPR of 10% were calculated and compared to empirical results.…”

“…In a recent prospective observational study in a population of 2287 singleton pregnancies undergoing routine screening at 35-37 weeks' gestation, we found that, first, the second to first peak of systolic velocity ratio (PSV ratio) ( Figure 1) was the only ophthalmic artery index that provided useful prediction of PE, second, there was good correlation between the first and second measurements of the ratio from the same eye, but poorer correlation between the first and second measurements between the two eyes, and it was estimated that the best performance of screening for PE was achieved by taking the average of four measurements (two from each eye), and, third, the detection rate (DR) of maternal factors, at a 10% false-positive rate (FPR), for delivery with PE at any time after assessment was 25%, and this increased to 50% with the addition of the PSV ratio; the respective values for delivery with PE within 3 weeks after assessment were 32% and 58% 16 . The objective of this study, in the same population undergoing routine screening at 35-37 weeks' gestation as in the abovementioned study 16 , was to examine the performance of maternal ophthalmic artery PSV ratio in combination with the established biomarkers of PE, including mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), in the prediction of subsequent development of PE.…”

“…The objective of this study, in the same population undergoing routine screening at 35–37 weeks' gestation as in the abovementioned study 16 , was to examine the performance of maternal ophthalmic artery PSV ratio in combination with the established biomarkers of PE, including mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum soluble fms‐like tyrosine kinase‐1 (sFlt‐1), in the prediction of subsequent development of PE.…”

Ophthalmic artery Doppler in the prediction of preeclampsia

“…A study in which waveforms were obtained in sequence from the right eye, left eye, and again right eye and then left eye found that there was good correlation between the first and second measurements from the same eye but poorer correlation in the first and second measurements between the 2 eyes. 5 It was estimated that the best performance of screening for PE was achieved by taking the average of 4 measurements (2 from each eye); satisfactory results were also achieved by taking the average of 1 measurement from each eye.…”

Ophthalmic artery Doppler in prediction of pre‐eclampsia: insights from hemodynamic considerations

“…In addition, the authors found a negative relationship between PR and gestational age at delivery with PE, i.e. earlier deliveries with PE were preceded by higher PR in the OA (figure 2a, Sapantzoglou et al 1 ; figure 2a, Sarno et al 2 ). This gradual change represents an important specification, substantiating the predictive capacity of the systolic waveform PR, and a convincing concept of the preclinical phase of PE.…”