First Trimester Screening for Preeclampsia and Intrauterine Growth Restriction Using Uterine Artery Doppler and Maternal Serum Placental Growth Factor and Pregnancy Associated Plasma Protein- A

Abstract

Objective: To assess the accuracy of first-trimester uterine artery Doppler indices combined with maternal serum placental growth factor (PlGF) and pregnancy associated plasma protein- A (PAPP-A) in the prediction of preeclampsia (PE) and intrauterine growth restriction (IUGR) in low risk pregnancy. Design: Prospective observational study. Patients and methods: A total of 266 low risk singleton pregnant women at12-14 weeks’ gestation were recruited and completed the study. Uterine artery (UtA) color Doppler study was estimated on the two sides, the mean pulsatility index (PI) was calculated and dicrotic diastolic notches were recorded. Estimation of maternal serum PlGF and PAPP-A were performed on the same day. The cut-off of Ut Ar PI was 2.35, the cut-off of PlGF was 12pg/ml and the cut off of PAPP-A was 0.42 MoM. The patients were followed up to detect PE and IUGR. PE developed in 14 cases (5.26 %), 2 cases early-onset 2 cases and late-onset 12 cases and IUGR in 19 cases (7.14 %), early-onset 3 cases and late-onset 16 cases. The sensitivity, specificity, positive and negative value (PPV and NPV) and accuracy were calculated. The higher sensitivity and PPV and accuracy for prediction of PE and IUGR were found when first trimester UtA PI and PlGF were combined. The addition of PAPR-A did not improve the accuracy. Conclusion: The ideal first trimester markers for prediction of PE and IUGR in low risk pregnant women may be a combination of UtA PI and maternal serum PlGF.