First-trimester uterine artery Doppler and PAPP-A levels as predictors of pre-eclampsia in a South Asian population; Mardan city, Pakistan

Abstract

One of the most common causes of maternity and neonatal fatalities and mortality is Pre-eclampsia (PE) which is responsible for 14% of global maternal deaths. The condition is primarily attributed to impaired trophoblastic invasion, which increases uterine artery pulsatility index (PI). A predictive analysis was done at Swat Medical College and Women's Hospital in Mardan, Pakistan from June 2022 to June 2023, including 218 pregnant women aged 11-13+6 weeks. Females with multifetal pregnancies, congenital fetal anomalies, and pre-existing medical conditions were excluded from this research. Uterine artery the Doppler and the PAPP-A testing were done to screen the conditions. Of 624 screened women, 218 were included in the final analysis using SPSS. The study population's mean age was 28 years, with 59% primiparous and 41% multiparous women. The incidence of PE was 35.5%, and gestational hypertension was 22.5%. Women developing hypertensive disorders had significantly higher mean uterine artery PI (2.11) compared to normotensive women (1.21, p=0.01), and significantly lower mean PAPP-A MoM levels (0.78 vs. 1.42, p<0.001). Coupled aberrant uterine blood vessels PI and PAPP-A predicted PE with high significance (p<0.001). Uterine artery in the first trimester Doppler and PAPP-A levels are effective in predicting pre-eclampsia in a South Asian population. Implementing these screenings could enhance early detection and management of PE, potentially reducing associated morbidity and mortality.