Predicting the risk of preeclampsia and small for gestational age infants by uterine artery Doppler in low-risk women

Abstract

The objective was to assess the value of uterine artery notching as a screening test for preeclampsia and fetal growth restriction in a low-risk population of healthy pregnant women. Color Doppler ultrasound was used to examine both uterine arteries in 322 healthy pregnant women at 24.9 +/- 1.9 (range 22-28) weeks of gestation. The criterion for abnormal results was a unilateral or bilateral presence of an early diastolic notch. The major end points were preeclampsia and small for gestational age (SGA) infants. Of the 322 women, 19 (5.9%) developed preeclampsia and six of them (1.9%) delivered SGA infants. An early diastolic notch was detected in 58 women (18%). The risk of developing preeclampsia and SGA infants in an abnormal Doppler study group was found to be greater than in that of a normal group (P<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting preeclampsia were 36.8, 83.2, 12.1, and 95.5%, respectively; whereas detecting SGA infants were 67, 82.9, 6.9, and 99.2%, respectively. Women with an early diastolic notch have considerably a higher risk of developing preeclampsia and SGA infants. On the other hand, women with normal uterine artery waveforms are unlikely to develop preeclampsia and SGA infants. The test may be useful to minimize unnecessary interventions.

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

“…Uterine Doppler waveforms analysis has become a valuable tool in the evaluation of the placental circulation and in the prediction of pregnancy outcome. Increased placental vascular impedance is frequently related to FGR and pregnancy-induced hypertension, 1,3,6,[7][8][9][10][11][12] which are still unsolved severe clinical problems associated with an increased maternal and perinatal mortality and morbidity. Maternal uterine artery Doppler in the second trimester of pregnancy helps the obstetricians to select patients at high risk for these complications but with a too low positive predictive value.…”

“…Since the introduction of uterine artery Doppler as an early screening test for complications in pregnancy in the mid-1980s, conflicting results on its value have been reported as discussed by Papageorghiou et al 4 The persistence of bilateral notches in uterine arteries associated with a quantitative resistance index cutoff at 24 weeks' gestation was reported to improve screening efficacy to identify patients at risk for complications in pregnancy. 1,7,8 The main problem is that second-trimester Doppler ultrasound evaluation of the uteroplacental circulation in asymptomatic patients (screening test) has been widely reported to have high-negative (97% to 99%) and low-positive predictive values for gestational hypertension and FGR (25% to 30%). 1,9 -12 Pregnancy is characterized by important changes in the maternal cardiovascular system.…”

Changes in Serum Calcium and Serum Magnesium Level in Preeclamptic vs Normal Pregnancy

“…Preeclampsia is still one of the leading causes of maternal and fetal morbidity and mortality 2 . The pathophysiological mechanism is characterized by a failure of the trophoblastic invasion of the spiral arteries which may be associated with an increased vascular resistance of the uterine artery and a decreased perfusion of the placenta 3 . Despite active research for many years, the etiology of this disorder remains unknown, although contributory factors include obesity, diabetes, calcium deficiency, older maternal age and job stress 4,5,6 .…”

Estimation of Serum Calcium and Magnesium in Preeclampsia and Eclampsia

“…The pathophysiological mechanism is characterised by a failure of the trophoblastic invasion of the spiral arteries, which may be associated with an increased vascular resistance to the uterine artery and a decrease perfusion of the placenta. 2 But the exact aetiology is still unknown, various hypothesis in the occurrence of preeclampsia have been set including the increase in thromboxane levels and the decrease in PGI2 levels as well as an imbalance of lipid peroxidise and antioxidants. However, the results from many clinical studies show the relationship between the aggravation of the hypertension complications and the change in the concentration of various chemicals in the mother's serum.…”