High performance of maternal characteristics and assessment of uterine artery Doppler waveform for the prediction of early-onset preeclampsia

Abstract

I read with great interest the recent article of Sonek et al, 1Sonek J. Krantz D. Carmichael J. et al.First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume.Am J Obstet Gynecol. 2018; 218: 126.e1-126.e13Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar who assessed the detection rate (DR) of first-trimester screening for early-onset preeclampsia (EOPE) at 11–13+6 weeks’ gestation using maternal characteristics, biochemical markers, and uterine artery Doppler (UAD). EOPE is associated with a much higher adjusted hazard ratio for perinatal death/severe neonatal morbidity than late-onset preeclampsia, and Sonek et al1Sonek J. Krantz D. Carmichael J. et al.First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume.Am J Obstet Gynecol. 2018; 218: 126.e1-126.e13Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar found that their first-trimester screening using a combination of maternal characteristics, preeclampsia history, UAD, and biochemical markers was associated with an 85% DR for a 5% false-positive rate. Unfortunately, the use of biochemical markers is an issue in some regions in terms of availability and cost, and Sonek et al did not assess the DR of EOPE using a combination of maternal characteristics, preeclampsia history, and UAD, which, yet, can detect at 11–13+6 weeks’ gestation more than 80% of patients at risk for early-onset preeclampsia,2Plasencia W. Maiz N. Poon L. Yu C. Nicolaides K.H. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia.Ultrasound Obstet Gynecol. 2008; 32: 138-146Crossref PubMed Scopus (139) Google Scholar allowing an efficient approach at a lower cost and aspirin prophylaxis in the women who test positive. Even better, using a multiple regression analysis, Plasencia et al2Plasencia W. Maiz N. Poon L. Yu C. Nicolaides K.H. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia.Ultrasound Obstet Gynecol. 2008; 32: 138-146Crossref PubMed Scopus (139) Google Scholar showed that maternal variables, uterine artery pulsatility index (PI) at 11+ 0 to 13+6 weeks’ gestation and the change in uterine artery pulsatility index between 11+0 to 13+6 and 21+0 to 24+6 weeks' gestation provided significant independent contributions to the prediction of preeclampsia, with as high as 90.9% DR for EOPE for a 5% false-positive rate. Indeed, in a normal pregnancy, impedance to flow in the uterine arteries steadily decreases with gestational age from the first to the second trimester, as the consequence of the physiological change of spiral arteries into low-resistance vessels. By taking into account the abnormal persistence of high resistance to flow in the uterine arteries, a strong correlation of persistent abnormal UAD pattern between the first and second trimesters with the subsequent development of EOPE3Herraiz I. Escribano D. Gómez-Arriaga P.I. Herníndez-García J.M. Herraiz M.A. Galindo A. Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia.Ultrasound Obstet Gynecol. 2012; 40: 68-74Crossref PubMed Scopus (21) Google Scholar, 4Gomez O. Figueras F. Martinez J.M. et al.Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome.Ultrasound Obstet Gynecol. 2006; 28: 802-808Crossref PubMed Scopus (95) Google Scholar and with lower birthweight3Herraiz I. Escribano D. Gómez-Arriaga P.I. Herníndez-García J.M. Herraiz M.A. Galindo A. Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia.Ultrasound Obstet Gynecol. 2012; 40: 68-74Crossref PubMed Scopus (21) Google Scholar was found. The same performance of screening by reserving second-trimester Doppler testing for only the women with the high resistance after first-trimester screening may both improve the DR of EOPE and allow a more targeted follow-up in the patients at higher risk of adverse obstetrical and perinatal outcome. First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volumeAmerican Journal of Obstetrics & GynecologyVol. 218Issue 1PreviewPreeclampsia is a major cause of perinatal morbidity and mortality. First-trimester screening has been shown to be effective in selecting patients at an increased risk for preeclampsia in some studies. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 218Issue 5PreviewWe thank Professor Carbillon for his interest in our recently published study and his comments. We agree with his general statements regarding early-onset preeclampsia (EOPE) and its effect on perinatal death and severe morbidity. Consequently, there is a need for the development of effective EOPE screening and prevention. Full-Text PDF