Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

Background: This study was conducted to evaluate the efficacy of different biochemical and biophysical markers in the early weeks of gestation as screening tools for early prediction of preeclampsia.Methods: This hospital-based prospective observational study conducted on 52 pregnant women, at less than 13 weeks of gestation were recruited. Maternal serum inhibin A and USG uterine artery PI levels were analyzed among the pregnant women who subsequently developed PE and compare with those who did not develop PE. Methods used for the detection of markers were: chemiluminescence immunoassay (CLIA) for serum inhibin A levels, and uterine artery Doppler velocimetry was done by PHILIPS HD11XE transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer.Results: The present study revealed a significant rise of inhibin A in preeclamptic women when compared to normotensive women (p<0.0001). The mean levels of 1st and 2nd trimester uterine artery PI significantly high in women who subsequently developed PE when compared to those who did not develop preeclampsia (p<0.0001). Study results showed a strong association between gestational age at delivery and neonatal outcome (neonatal birth weight and APGAR) with preeclampsia. The maternal serum inhibin A, and uterine artery PI found to have good sensitivity and specificity for early prediction of PE.Conclusions: Study concluded that the women who are prone to develop PE subsequently, had high levels of MAP, UAPI, inhibin A. In our setting, MAP, UAPI, inhibin A, appeared to be better screening modalities. Combination of the biochemical markers with the biophysical markers, demographic characteristics, and other novel markers will establish the effective screening models for early prediction of PE. Early identification of high-risk cases will offer an opportunity for prophylactic therapy, such as Low- dose Aspirin in selected groups of high-risk women screened in the first trimester, thus improving the maternal and perinatal outcome.

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Potential screening strategies for early prediction of pre-eclampsia

Hymavathi

Davuluru

Shaik

et al. 2021

“…15 Narang S et al, conducted a study on prediction of preeclampsia at 11-14 weeks of pregnancy using uterine artery doppler indices found similar sensitivity (75.9%) and specificity (79.6%) of uterine artery doppler PI as reported in the present study. 16 sFlt-1/Plgf had highest positive predictive value (PPV) of 80% as well as best negative predictive value (NPV) of 95%. Zeisler H et al did a study in which they found that NPV of sFlt-1/Plgf was 99.3% which is almost like our study.…”

Section: Gomezmentioning

confidence: 99%

Comparative study of sFlt-1/Plgf ratio with uterine artery doppler indices in prediction of preeclampsia at 22-24 weeks period of gestation

Gupta

Sharma

Arora

et al. 2020

Background: Hypertensive disorders like pre-eclampsia along with hemorrhage and infection, contributes greatly to maternal morbidity and mortality. Various pro and antiangiogenic factors like sFlt-1 and Plgf have been linked to the etiopathogenesis of placental vascular disease and their combination with uterine artery doppler studies may improve the prediction accuracy. Present study was conducted to analyze sFlt-1/Plgf ratio and uterine artery doppler indices among high risk patients and to compare these in prediction of preeclampsia.Methods: A prospective observational study was conducted from September 2017 to February 2019 in which 100 patients giving consent and satisfying inclusion criteria were evaluated for various risk factors and were subjected to sFlt-1/Plgf ratio test and uterine artery doppler study at 22-24 weeks period of gestation. They were followed up and maternal outcome was analysed.Results: Among the cohort of 100 women with high risk factors, 35% of the study participants developed pre-eclampsia. Using sFlt-1/Plgf ratio 40% of them were screened positive for pre-eclampsia. This percentage of screened positive was 40%, 43%, and 53% using uterine artery RI, PI, and SD respectively. sFlt-1/Plgf was found to have a sensitivity of 91.4% and specificity of 87.7%. ROC curve analysis showed highest area under curve (AUC) for sFlt-1/Plgf (0.858).Conclusions: sFlt-1/Plgf ratio was found to be a better predictable biomarker than uterine artery Doppler indices in prediction of pre-eclampsia at 22-24 weeks period of gestation.

The role of first trimester uterine artery pulsatility index as a predictor of hypertensive disorders of pregnancy in the department of obstetrics and gynaecology, Sawai Man Singh Medical College, Jaipur

Shivrayan

Vyas²,

Kuntal³

et al. 2022

Background: This study was conducted to assess the relationship between mean uterine artery pulsatility index at 11+0 to 13+6 weeks and the development of hypertensive disorders of pregnancy.Methods: This prospective study was carried out on 320 pregnant women. In all subjects mean uterine artery PI was calculated at 11+0 to 13+6 weeks and association of value of uterine artery PI and development of hypertensive disorder of pregnancy were compared by receiver operative curve analysis.Results: The ROC curve analysis shows that at the cut-off value of 1.62, overall sensitivity, specificity, positive predictive value, and negative predictive value of PI for prediction of hypertensive disorder of pregnancy in our study was 82.1% (95% CI- 63.1-93.9%), 57.4% (95% CI- 51.5-63.2%), 15.7% (95% CI- 13.1-18.9%) and 97.1% (95% CI-93.7-98.7%) respectively. When we evaluate 11+0 to 13+6 weeks UtA PI value with hypertensive disorders of pregnancy and early-onset hypertensive disorders of pregnancy by AUC curve, we found that the area under curve was 0.73 (95% CI 0.64-0.81) and 0.78 (95% CI 0.69-0.86) respectively.Conclusions: Uterine artery pulsatility index at 11+0 to 13+6 weeks is significantly higher in women who develop hypertensive disorder in pregnancy. Our study also shows that 11±0 to13±6 weeks uterine artery pulsatility index was a more significant predictor of early onset pre-eclampsia. It is a simple, non-invasive, reliable test which can be performed as an adjunct to routine ultrasound examination to predict hypertensive disorders.