First-Trimester Uterine Artery Doppler and Serum Pregnancy-Associated Plasma Protein-A in Preeclampsia and Chromosomal Defects

Abstract

Objective: We examined the potential value of the uterine artery pulsatility index (PI) in pregnancies with fetal aneuploidies and in those that developed preeclampsia (PE) with the aim of distinguishing between these complications in pregnancies with low pregnancy-associated plasma protein-A (PAPP-A). Methods: Uterine artery PI and serum PAPP-A at 11–13 weeks were measured in 165 cases of PE, including 33 that required delivery before 34 weeks (early PE) and 132 with late PE, and in 301 cases with aneuploidies, including 200 with trisomy 21. Each case of aneuploidy and PE was matched with 4 unaffected controls. Results: Serum PAPP-A was lower in early PE (0.58 multiples of the normal median, MoM) and in trisomy 21 (0.54 MoM), trisomy 18 (0.22 MoM) and Turner syndrome (0.51 MoM) – but not in late PE (0.90 MoM) – than in controls (1.01 MoM). Uterine artery PI was higher in early PE (1.52 MoM), late PE (1.20 MoM), trisomy 18 (1.20 MoM) and Turner syndrome (1.29 MoM) – but not in trisomy 21 (1.02 MoM) – than in controls (1.0 MoM). Conclusion: The uterine artery PI at 11–13 weeks may be useful in distinguishing between low PAPP-A due to trisomy 21 and early PE.