Uterine Artery Doppler in Women with History of Previous Pre Eclampsia and Women with Chronic Hypertension: Re-evaluation of a Prognostic Value in a High-Risk Population

Abstract

Objective: To evaluate the prognostic role of uterine artery Doppler for pre-eclampsia in high-risk patients. Because of the higher prevalence of new onset of disease in a high-risk population, a better performance could be expected in this special group. Methods: This retrospective study compares uterine artery Doppler to predict pre-eclampsia in patients with a history of pre-eclampsia and also in patients with chronic hypertension, both with high-risk to develop recurrent, superimposed or new onset pre eclampsia. Doppler measurements of uterine arteries were performed every 4 weeks in the 1st and 2nd trimester. Results: Pre-eclampsia occured in 33% of current high-risk pregnancies. The best performance of pre eclampsia was provided by bilateral notching plus increased PI ≥ 2.5, both in the 1st and 2nd trimester. In the 1st trimester the specifity was 81% (95% CI: 58-95) in the Prior PE group and 95% (95% CI: 74-100) in the C. H. group. In the 2nd trimester the sensitivity was 97% (95% CI: 86-100) in the Prior PE group and 100% (95% CI: 93 100) in the C. H. group. Sensitivity was very low in the 1st and 2nd trimester. Conclusion: Our results show, that the negative predictive value of uterine artery Doppler works well even in a high risk group. Data however suggest relative poor positive predictive value of uterine artery Doppler even in a high-risk population using a cut-off of 2.5 PI. A value of the uterine artery Doppler using a high cut-off might be in the increased specifity. Nevertheless, a combination of the uterine artery Doppler with biochemical markers and maternal parameters seems to be essential.