Abstract
To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women. The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram. Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64-21.13; and OR: 10.32; 95%CI: 2.75-42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58-1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55-0.97) in the 3rd trimester was associated with late PE. Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE.
Highlights
Analysis in the 1st and 3rd trimester showed that abnormal uterine artery pulsatility index (UtAPI) was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64–21.13; and odds ratio (OR): 10.32; 95%CI: 2.75–42.49, respectively)
The KaplanMeier curve showed that a UtAPI of 0.76 (95%CI: 0.58–1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55–0.97) in the 3rd trimester was associated with late PE
Of the patients evaluated in the 3rd trimester, 12.7% (67) of women who were in the 3rd trimester of gestation had a UtAPI > 95th percentile; the highest percentage of patients with UtAPI > 95th percentile was in the group of early PE (75%) (6 patients of the 8 that developed early PE)
Summary
Pre-eclampsia (PE) is a disease with a high percentage of maternal and perinatal complications and continues to be one of the main causes of maternal death worldwide.[1,2,3,4] Several methods have been studied to classify low- and high-risk populations; in recent years, early screening has been increasingly performed in an attempt to reduce PE prevalence through specific pharmacological interventions.[4,5,6] Several research groups, such as the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynecologists (ACOG), and the Fetal Medicine Foundation (FMF), have analyzed screening methods for PE in which different parameters regarding maternal history, clinical symptoms, laboratory results, and biophysical variables are evaluated. Relevant international studies have evaluated the distribution of UtAPI in different populations during the course of pregnancy.[1,7,16,17,18] In Latin America, there are no comparable studies that provide information about these values throughout the pregnancy or their association with PE
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