Utility of Placental Laterality and Uterine Artery Doppler Abnormalities for Prediction of Preeclampsia

Abstract

Objective To find out whether placental laterality and abnormal uterine artery waveform and resistance index, as determined by antenatal ultrasonography and Doppler, can be used as a predictor for the development of preeclampsia. Methods This prospective observational cohort study was conducted from August 2013 to October 2014. Two hundred and one (201) normotensive, primigravida women with singleton pregnancies attending the antenatal clinics without any high-risk factor for development of hypertension were subjected to ultrasonography at 18-22 weeks of gestation to determine the placenta location. All the subjects with lateral placentas were subjected to Doppler ultrasonography to look for abnormal Doppler waveform and resistance index. They were followed for the development of preeclampsia till 40 weeks of gestation or delivery. Result In subjects with lateral placentas alone (n = 33), 2 (6 %) developed preeclampsia while as those with lateral placentas with Doppler abnormality (n = 38), 35 (92 %) developed preeclampsia (p \ 0.001). The overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio), and 95 % confidence interval was (4. 30-19.98). Conclusion Pregnant women with lateral placentas are at significant risk for development of preeclampsia. Lateral placentas when associated with uterine artery Doppler abnormality, risk for development of preeclampsia increases significantly as compared to lateral placentas alone.

A prospective observational study to determine the utility of placental laterality for prediction of preeclampsia in pregnancy

“…[10][11][12] These differences may be due to differences in the criteria defining central and lateral placenta. In this study, lateral placenta was considered only when 70 % or more of the placenta was on one side of the uterine cavity, which was in accordance to the Indian study by Yousuf et al 9 In comparison, Devarajan et al assigned the placental position as central/fundal or lateral using the maternal aorta as midline. 13 The association between placental laterality and development of PIH has been examined previously with controversial results.…”

“…Few showed significant relationship between laterally located placenta and preeclampsia whereas few found no relation between the two. 9,11,[14][15][16] Study did not observe any association between placental laterality and development of preeclampsia. A single subject developed preeclampsia in the present study and the placenta was central in this subject.…”

“…In a similar study done by Yousuf et al, it was observed that primary infertility (p value 0.003) and lateral placenta (p value < 0.001) were independent risk factors for development of preeclampsia. 9 After applying logistic regression, they found that overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio) with 95% confidence interval of 4.306-19.978.…”

“…Yousuf S et al, observed that the overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio). 9 Taking these values as reference, the minimum required sample size (with 99% power of study and 1% level of significance) was 104 patients. Taking lost to follow up as 20%, sample size to be taken was 130.…”

First trimester Doppler velocimetry of the uterine artery ipsilateral to the placenta improves ability to predict early-onset preeclampsia

“…[19] The lower value of the placental-side UtA PI (as compared with the non-placental-side UtA PI observed in our study) was also noted by some previous studies. [19–23]…”