Second-trimester Uterine Artery Doppler Research Articles

The role of second trimester uterine artery Doppler in predicting obstetric and neonatal outcomes in abnormal first trimester maternal serum pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin values.

This study aims to determine whether second-trimester uterine artery (UtA) Doppler combined with first-trimester abnormal pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-Hcg) levels predicts adverse obstetric and neonatal outcomes. This study of 289 pregnant women included 196 with normal PAPP-A and free β-HCG values (control group) and 93 with abnormal values (study group) in the first-trimester screening test. Second-trimester UtA Doppler sonography was done in these pregnancies. The perinatal prediction and screening potential of UtA Doppler pulsatility index (PI) parameters were examined in the study group. UtA PI >95 percentile increased birth before the 37th week by 4.46 times, birth before the 34th week by 7.44 times, preeclampsia risk by 3.25 times, fetal growth restriction (FGR) risk by 4.89 times, and neonatal intensive care unit (NICU) admission rates by 3.66 times in the study group (p < 0.05 for all). UtA PI >95 percentile had 49.2% sensitivity and 82.1% specificity for birth before 37 weeks. For birth before 34 weeks, sensitivity was 80.0% and specificity 65.0%. FGR has 70.5% sensitivity and 67.1% specificity. Screening for preeclampsia has 66.6% sensitivity and 61.9% specificity. Adding UtA Doppler in the second trimester to pregnancies with abnormal PAPP-A and/or free β-Hcg values in the first trimester may be a useful screening method for adverse outcomes.

First trimester SHARP1 and second-trimester uterine artery Doppler to predict preeclampsia

Objectives The objective of this study was to identify the predictive value of the first-trimester serum SHARP1 level and the second-trimester uterine artery Doppler in singleton pregnancy for the prediction of preeclampsia. Methods A prospective study including singleton pregnancy presenting at an antenatal clinic, King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University from 2019–March 2020 was conducted. Serum SHARP1 was collected at the gestational age (GA) of 11–13+6 weeks, and transabdominal uterine artery Doppler ultrasound was performed at GA of 18–24 weeks. Serum SHARP1 level and uterine artery pulsatility index (PI) were combined to calculate the predictive value for preeclampsia detection. Results 288 pregnant women were enrolled in the first trimester, but only 249 participants completed the study. Thirteen patients had preeclampsia (5.2%), which three cases (1.2%) had early-onset preeclampsia. The median serum SHARP1 level in the first trimester of pregnant women with preeclampsia was lower than the normal pregnancy group (1392 pg/ml vs. 1941 pg/ml, p = 0.046). The second-trimester uterine artery PI and prevalence of early diastolic notching were higher in the preeclampsia group than in the normal pregnancy group (p = 0.029 and p = 0.001, respectively). When the first-trimester serum SHARP1 level is combined with the second-trimester uterine artery PI, the sensitivity, specificity, PPV, and NPV for preeclampsia prediction were 84.6%, 47.5%, 8.2%, and 98.3%, respectively. Conclusions This study demonstrated that serum SHARP1 level in the first trimester combined with the uterine artery PI in the second trimester had good sensitivity to predict preeclampsia.

Second-trimester Uterine Artery Doppler Pulsatility Index in Singleton Pregnant Women with and without Risk of Pre-eclampsia

Background: Preeclampsia (PE) is gestational hypertension and one of the most serious disorders in pregnant women. Objective: This study aimed to compare second-trimester uterine artery Doppler pulsatility index (UA-PI) in singleton pregnant women with and without risk of PE. Methods: A case-control study was carried out among 200 singleton pregnant women in the second trimester of pregnancy, who were referred to Imam Hospital in Ahvaz (Iran). The data were recorded on their demographic, obstetric, clinical characteristics, and Doppler indices. The average UA-PI value was considered as the mean PI between the right and left arteries. Women who were categorized into Groups 1 and 2 had a moderate-high and low risk of PE, respectively. Results: The mean UA-PI, right UA-PI, left UA-PI, systolic and diastolic blood pressures (BP), age, body mass index (BMI), and abdominal circumference (AC) of women in Group 1 were significantly higher than those in Group 2 (p&lt;0.05). Furthermore, Group 1 had a higher frequency of abortions, comorbidities, abnormal UA Doppler results, and nulliparous women than Group 2 (p&lt;0.05). Based on maternal age (&lt;35, ≥35), BMI (&lt;25, ≥25), comorbidities (yes, no), and nulliparity (yes, no) categories, those who were in Group 1 had a significantly higher mean systolic and diastolic BP, UA-PI, right UA-PI, and left UA-PI than their counterparts in Group 2 (P&lt;0.001). Conclusion: This study declared the second-trimester UA-PI had good potential for timely prediction of PE risk in pregnant women.

A Retrospective Cohort Study to Determine Whether the Previous Route of Delivery Affects the Uterine Artery Blood Flow.

In our study, we aimed to investigate the effect of the previous delivery route on uterine artery pulsatility index (PI) and obstetric outcome.We aim to assess the effects of previous cesarean delivery (CD) and placental location on first- and second-trimester uterine artery Doppler indices as well as first-trimester pregnancy-associated plasma protein-A (PAPP-A)multiples of the median (MoM) levels in the subsequent pregnancy. We designed a retrospective cohort study to collect the participants' clinical and uterine artery Doppler.Data regarding pregnant women's first- and second-trimester exams, who were referred to our maternal-fetal medicine unit, were collected from hospital records between June 2015 and December 2019. Uterine artery PI MoM values were not different between the cases with the anterior and non-anterior placental locations. No significant difference was found in the first- and second-trimester uterine artery PI MoMvalues by delivery route (p = 0.57). However, the intrauterine growth restriction rate was higher in the CD group (p < 0.001). In this study, we compared the uterine blood flow indices between the previous cesarean and vaginal delivery groups. We observed no significant difference between the patients with different delivery routes.

The Ability of Doppler Uterine Artery Ultrasound to Predict Premature Birth.

Demonstration of the predictive capacity of Doppler Uterine Artery (UtA) on preterm birth (PB) by serial measurement at various ages of pregnancy. The prospective study included a group of 116 pregnant women, of whom 85 gave birth prematurely and 31 pregnant women gave birth at term, constituting the control group. UtA Doppler measurement was performed by the abdominal approach. Quantitative wave evaluations were performed by the pulsatility index (PI), the systole/diastole ratio (S/D), as well as the qualitative analysis of the flow rate waveform (notch). UtA Doppler evaluation was performed in 3 pregnancy periods: 18.0-22.6 weeks, 28.0-31.6 weeks, and 32.0-35.6 weeks. Only at the third examination, at 32.0-35.5 weeks of gestation, was there a statistically significant difference between the S/D-UtA ratio and PI-UtA correlated with the risk of premature birth (p<0.05). Although there was an association between UtA Doppler and late preterm birth, the predictive ability was low. Also, UtA Doppler was not statistically significant for preterm birth before 32 weeks of gestation. Although we did not find a statistical association between second-trimester UtA Doppler and preterm birth, we do suggest a closer look at women with abnormal UtA Doppler in the second trimester. We believe that, according to the results obtained, UtA Doppler can predict especially iatrogenic premature birth depending on the prediction of the most severe complications, severe preeclampsia, and SGA.

Second-trimester Uterine Artery Doppler Parameters but not Triple Test Analytes, May Predict Gestational Diabetes Mellitus

Second-trimester Uterine Artery Doppler Parameters but not Triple Test Analytes, May Predict Gestational Diabetes Mellitus

Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications.

Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7-246/7 weeks' gestation) in a single tertiary referral center between 2016-2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight &lt; 3rd centile. A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06-0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84-35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71-0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57-0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74-0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58-68%] vs. 52% [95%-CI 47-57%]). Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.

Second-trimester serum high mobility group box-1 and uterine artery Doppler to predict preeclampsia

The objective of this study was to identify the predictive value for preeclampsia of second-trimester serum high mobility group box-1 (HMGB1) and uterine artery Doppler in singleton pregnancies. Between April 2020 and April 2021, a prospective study was conducted on singleton pregnancies with a gestational age of 16–20+6 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Maternal characteristics, uterine artery Doppler, and serum HMGB1 were collected. Serum HMGB1 levels and mean uterine artery pulsatility index (UAPI) were combined to calculate the predictive value for preeclampsia. A total of 393 pregnant women were analyzed, with 25 cases (6.4%) developing preeclampsia and 5 cases (1.3%) developing early-onset preeclampsia. Baseline characteristics of preeclampsia and normal pregnant women were comparable. Preeclamptic pregnant women had significantly higher mean serum HMGB1 levels than normal pregnant women (1112.8 ± 363.1 ng/mL vs 910.8 ± 486.1 ng/mL, p = 0.013). There was no difference in the mean UAPI. Any early-diastolic notching was found more frequently in the preeclampsia group (32.0% vs 12.5%, p = 0.013). The cut-off value for serum HMGB1 levels above 1.04 MoM as abnormal value to predict preeclampsia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88.0%, 53.5%, 11.4% and 98.5%, respectively. When using abnormal serum HMGB1 levels combined with mean UAPI above 95th percentile, the sensitivity, specificity, PPV and NPV to predict preeclampsia were 88.0%, 50.8%, 10.8% and 98.4%, respectively. This study showed that serum HMGB1 at 16–20+6 weeks of gestation were effective in predicting preeclampsia. The addition of UAPI did not improve the prediction performance.

Value of second-trimester uterine artery pulsatility index in pregnancies with systemic lupus erythematosus and/or antiphospholipid syndrome

Objective To assess the value of the second trimester mean pulsatility index of the uterine arteries (MPI-UtA) to predict adverse perinatal outcome (APO) in women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods Pregnancies with either an SLE diagnosis or with primary APS controlled at our Hospital during a 10 years period were included. MPI-UtA was performed between 19–23 weeks' gestation. The MPI-UtA was defined as abnormal when it was >95th centile. APO was defined as the presence of: preeclampsia (PE), small for gestational age (SGA) newborn, preterm delivery, placental abruption and fetal or neonatal death. Results There were 39 ongoing pregnancies, 16 of them with SLE and 23 with primary APS. Nine patients had no previous pregnancy (23%). Globally, 35 live births were recorded, being the mean gestational age at delivery 38.1 ± 2.1 weeks and the mean birth weight 2835 ± 492 g. Abnormal MPI-UtA was found in 6 (15%) pregnancies, all of them (100%) had an APO: there were 4 fetal deaths and 2 further severe PE with live newborn. Normal MPI-UtA was shown in the remaining 33 (84.6%); of them, 6 (18%) had an APO: one late PE with a premature newborn, another one severe preterm baby and 4 SGA term newborns. No cases of perinatal death occurred in this group. Therefore, accuracy of MPI-UtA evaluation for APO was: sensitivity 50%, specificity 100%, PPV 100% and NPV 82%, respectively (p < .001). Conclusion Abnormal second-trimester uterine artery Doppler evaluation is highly predictive for adverse perinatal outcome in pregnancies affected by SLE or APS.

633 Association of second-trimester uterine artery doppler abnormalities with maternal hypertension 2-7 years after delivery

Adverse pregnancy outcomes (APO) are associated with future maternal cardiovascular disease. Uterine artery Doppler (UAD) has been used to try to predict APO, and could indicate a greater chance of future maternal cardiovascular risk. We investigated associations between 2nd-trimester UAD parameters with development of new maternal hypertension (HTN) 2-7 years after delivery. The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) is a long-running, prospective cohort study that has followed a diverse cohort of 4475 US women since early in their 1st pregnancies. We calculated odds ratios and 95% confidence intervals for associations between abnormal UAD parameters and incident HTN. Women who had baseline chronic HTN, who did not undergo UAD in the index pregnancy, or who were missing data regarding HTN at follow up were excluded. We defined abnormal UAD as any of the following: presence of early diastolic notch, elevated resistance index (RI), or elevated pulsatility index (PI). We defined HTN as systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥80 mmHg, or self-reported use of an anti-HTN medication at the nuMoM2b-HHS study visit. Models were adjusted for age, BMI, self-reported race/ethnicity, insurance status, smoking, and APO. We tested for interactions between abnormal UAD and APO. A total of 3737 women were included in the analysis, of whom 187 (5%) developed HTN after the index pregnancy (Table 1). The abnormal UAD composite exposure was not associated with incident HTN. However, higher maximum RI and PI were each significantly associated with higher odds of incident HTN (Table 2). APO during the index pregnancy did not significantly modify this association. In this prospective cohort of women followed from early pregnancy, having either a higher RI or PI in the early 2nd trimester was associated with higher odds of developing HTN years after delivery. These UAD abnormalities may be early biomarkers of underlying maternal vascular dysfunction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prediction of pregnancy complications by second-trimester uterine artery Doppler assessment in monochorionic twins.

We aimed to investigate whether transabdominal uterine artery (UtA) pulsatility index (PI) differs between monochorionic (MC) diamniotic and dichorionic (DC) twins and is useful to predict pregnancy complications. A total of 406 uncomplicated twin pregnancies (94 MC, 312 DC) were examined at 22+0 -24+6 weeks and compared for demographic characteristics, mean UtA PI, presence of notch, development of preeclampsia, fetal growth restriction (FGR), placental abruption, intrauterine fetal death and preterm delivery. Mann-Whitney and Fisher's exact tests were performed for continuous and categorical variables, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated for mean PI >95th percentile, presence of notch, and presence of either elevated PI or notch. Median mean UtA PI was 0.68 in DC and 0.75 in MC pregnancies (P = .005). Bilateral notches were observed in one MC pregnancy; unilateral notch was seen in 8 DC (2.6%) and 5 MC diamniotic (5.3%) pregnancies. FGR occurred more frequently in DC twin pregnancies, while intrauterine fetal death in MC. Overall, the sensitivity of the parameters tested was low. Pregnancies with both PI above 95th percentile and presence of notch were all associated with complications, particularly FGR. MC pregnancies have higher mean UtA PI. UtA screening in twins shows lower performances than in singletons for the detection of complications.

P17.05: Relationship between uterine artery Doppler and the risk of stillbirth in our population

The aim of this study was to determine the relationship between uterine artery Doppler in the second trimester and stillbirths in routinely screened women in our population through a retrospective study. This is a retrospective study performed between August 2007 and May 2016 in a single obstetric unit. Second-trimester uterine artery Doppler pulsatility indices (PI) at 19 to 22 weeks of gestation were obtained from a cohort of 17765 women following routine gestational controls at our centre. Uterine artery PI examinations were performed . PI>95th percentile was defined as an abnormal Doppler. The 95th percentiles of the mean uterine PI was calculated according to each gestational week. The 36 (0.2%) pregnancy losses were obtained from the hospital computerised maternity database and cross-linked to the Doppler database. From our study group, we obtained 36 stillbirths. Analysis showed that the MoMPI median for stillbirths was 0,9323 while the same parameter for the rest was 0,8705. Likewise the Log (MoMPI) mean for stillbirths -0,1348 while the same parameter for the rest was -0,1862 (p<0,05). Considering that, we didn't obtain any statistically significant differences in PI factors between women who had a stillbirth and women with healthy neonates once we applied the Chi-square and Fisher's exact tests. Although we have obtained an odds ratio of 22 risk of stillbirths in cases of IP>95 against cases of IP<95, this is not statistically significant (p>0.05; 95%CI [0.68-7.20]). We have also performed a logistic regression showing no relationship between uterine artery IP in a continuous way and the stillbirths (OR:1.77[0.60-4.42]). We have not found a statistically significant relationship between uterine artery Doppler PI and stillbirth. Although we found a tendency to have higher PI in patients who finally had a stillbirth, this is not statistically significant. Studies are needed with larger number of cases to find out if this tendency can be significant.

Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.

Changes in uterine artery Doppler velocimetry and circulating angiogenic factors in the first half of pregnancies delivering a small-for-gestational-age neonate.

To assess the relationship between longitudinal changes in placental Doppler indices and maternal circulating angiogenic factors in the first half of pregnancy and delivery of a small-for-gestational-age (SGA) neonate, and ascertain whether longitudinal evaluation of these variables improves the prediction achieved by second-trimester cross-sectional evaluation. From a prospective cohort of unselected singleton pregnancies undergoing first-trimester screening for aneuploidy, 138 were included in this study. Of these, 46 were complicated by SGA (delivering after 34 weeks' gestation with a birth weight < 10th centile) and 92 were appropriate-for-gestational-age (AGA) pregnancies, which were included as controls (ratio 1:2). First-to-second trimester longitudinal changes in uterine artery (UtA) Doppler indices and maternal circulating levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were analyzed. Compared with the AGA group, SGA pregnancies had significantly higher UtA impedance in the first (Z-score: 0.46 vs -0.57; P < 0.001) and second (Z-score: 1.71 vs -0.75; P < 0.001) trimesters. Likewise, the sFlt-1/PlGF ratio was significantly higher in SGA than in AGA pregnancies in the first (98.0 vs 67.9; P = 0.01) and early second (22.4 vs 8.8; P < 0.001) trimesters. The predictive performance of the longitudinal changes in UtA Doppler indices for SGA was significantly lower than that of second-trimester cross-sectional values (area under receiver-operating characteristics curve (AUC), 60.8% vs 84.3%; P = 0.0035). The detection rate of SGA, at a 10% false-positive rate (FPR), was 17.7% by longitudinal changes in UtA Doppler and 56.2% by second-trimester cross-sectional UtA Doppler values. Similarly, the predictive performance of the longitudinal changes in PlGF was significantly lower than that of early second-trimester cross-sectional values (AUC, 71.4% vs 76.5%; P = 0.008). The detection rate of SGA at a 10% FPR was 40.6% when screening by longitudinal changes in PlGF and 52.1% when screening by early second-trimester cross-sectional values. First- and second-trimester UtA Doppler velocimetry and maternal circulating angiogenic markers have clinical utility as a cross-sectional assessment for the identification of pregnancies at high risk of delivering a SGA neonate, however, they do not improve prediction when their longitudinal changes are used. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

THE ROLE OF SECOND TRIMESTER UTERINE ARTERY DOPPLER ULTRASOUND,INHIBIN-A AND PLACENTAL GROWTH FACTOR IN PREDICTION OF PREECLAMPSIA.

ABSTRACT Objective: to evaluate the role of second trimester uterine artery Doppler ultrasound velocimetry (UADV), maternal serum Inhibin-A andplacental growth factor (PLGF) concentrations and as predictors of preeclampsia. Study design: Cohort study. Methodology: This prospective study was conducted at Obstetrics & Gynecology department, Alazhar University hospitals, Cairo, Egypt between May 2012 and May 2014. Ninety low risk normotensive singleton pregnant women were recruited for the study. Blood samples were collected at 16- 18 weeks, centrifuged to extract the serum then stored at – 80 °C until tested for inhibin-A and free PLGF levels. At 22-24 weeks, bilateral uterine artery Doppler velocimetry were recorded. The primary outcome was preeclampsia defined as hypertension with proteinuria after 20 weeks gestation. Women who developed preeclampsia were compared against normotensive control group. Statistical analysis: Receiver operating characteristics (ROC) curves were used for detection of the sensitivity and specificity and cut off value for each predictor using SPSS version 21 for analysis (IBM Inc., Chicago, Illinois, USA). Results: Eight cases out of 90 had developed preeclampsia. Women who developed preeclampsia had significantly higher median uterine artery resistance index (UARI) (0.645 ± 0.3 vs. 0.485 ± 0.16, P = 0.009) and significantly lower median uterine artery pulsitility index (UAPI) (0.625 ± 0.24 vs. 1.0 ± 0.68 with P= 0.001) than normotensive control group.Maternal serum inhibin-A level was significantly higher in women with preeclampsia than the normotensive control group (1375 ± 1431 vs. 540 ± 1900 with P = 0.016) while level of PLGF was non-significantly lower in women with preeclampsia than the normotensive control group (275.5 ± 369 vs. 390 ± 583 with P = 0.156). ROC curves were analysed for cases and control groups, areas under the curve (AUC) was 0.709 (95% CI, 0.527– 0.891, P = 0.016) for UARI with sensitivity of 87.5%, specificity 74% at cut off value ≥ 0.5650, AUC was 0.848 (95% CI, 0.742– 0.955, P = 0.001) for UAPI with sensitivity of 80%, specificity 74% at cut off value ≤ 0.735, AUC was 0.758 (95% CI, 0.566 - 0.951, P = 0.016) for Inhibin-A with a sensitivity of 75%, specificity of 80% at cut off value of ≥ 832.5 pg/ml and finally AUC was 0.652 (95% CI, 0.447 – 0.858 and P = 0.165) for PLGF with a sensitivity of 74% and specificity of 50% at cut off value of ≤ 205 pg/ml. Conclusion: second-trimester uterine artery Doppler indices, serum Inhibin-A and PLGF and may be helpful as a predicting markers for preeclampsia. Key words: Inhibin-A, placental growth factor, Doppler indices, uterine artery, Preeclampsia.

Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial.

To ascertain whether screening for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) by uterine artery (UtA) Doppler in the second trimester of pregnancy and targeted surveillance improve maternal and perinatal outcomes in an unselected population. This was a multicenter randomized open-label controlled trial. At the routine second-trimester anomaly scan, women were assigned randomly to UtA Doppler or non-Doppler groups. Women with abnormal UtA Doppler were offered intensive surveillance at high-risk clinics of the participating centers with visits every 4 weeks that included measurement of maternal blood pressure, dipstick proteinuria, fetal growth and Doppler examination. The primary outcome was a composite score for perinatal complications, defined as the presence of any of the following: PE, IUGR, spontaneous labor < 37 weeks' gestation, placental abruption, stillbirth, gestational hypertension, admission to neonatal intensive care unit and neonatal complications. Secondary outcomes were a composite score for maternal complications (disseminated intravascular coagulation, maternal mortality, postpartum hemorrhage, pulmonary edema, pulmonary embolism, sepsis), and medical interventions (for example, corticosteroid administration and induction of labor) in patients developing placenta-related complications. In total, 11 667 women were included in the study. Overall, PE occurred in 348 (3.0%) cases, early-onset PE in 48 (0.4%), IUGR in 722 (6.2%), early-onset IUGR in 93 (0.8%) and early-onset PE with IUGR in 32 (0.3%). UtA mean pulsatility index > 90(th) percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UtA Doppler vs non-Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had more medical interventions, such as corticosteroid administration (relative risk (RR), 1.79 (95% CI, 1.4-2.3)) and induction of labor for IUGR (RR, 1.36 (95% CI, 1.07-1.72)). In women developing PE or IUGR, there was a trend towards fewer maternal complications (RR, 0.46 (95% CI, 0.19-1.11)). Routine second-trimester UtA Doppler ultrasound in an unselected population identifies approximately 60% of women at risk for placental complications; however, application of this screening test failed to improve short-term maternal and neonatal morbidity and mortality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Predictive accuracy of second-trimester uterine artery Doppler indices for stillbirth: a systematic review and meta-analysis.

To assess the predictive accuracy for stillbirth of second-trimester uterine artery Doppler. We searched MEDLINE, EMBASE and The Cochrane Library databases from inception until March 2015 without language restrictions. The included studies were those that assessed the association of abnormal uterine artery Doppler parameters and stillbirth. Two independent reviewers selected the studies, extracted data and assessed quality. Results for studies that were performed in the second trimester were pooled and summary estimates of sensitivity, specificity, likelihood ratios and their 95% confidence intervals were obtained. An overall summary of test accuracy was provided by the diagnostic odds ratio. Subgroup analysis was performed according to whether the study population was high risk or unselected. Literature searches returned 338 relevant citations with 32 considered in full. Thirteen studies met our search criteria (85 845 women, 508 stillbirths) and were included in the review. Bivariate pooled estimate for sensitivity was 65% (95% CI, 38-85%) and for specificity 82% (95% CI, 72-88%). The positive likelihood ratio was 3.5 (95% CI, 2.3-5.5) and negative likelihood ratio 0.43 (95% CI, 0.22-0.85). The diagnostic odds ratio was 8.3 (95% CI, 3.0-22.4). Heterogeneity was high in the studies of high-risk women. Abnormal uterine artery Doppler indices are associated with a three- to four-fold increase in the risk of stillbirth. The heterogeneity was particularly high in the high-risk group rendering it impossible to draw firm conclusions. In view of this, there is a role for individual patient data meta-analysis to define which Doppler parameter and threshold value should be measured.

Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome

The aims of this study were evaluation of the association of reduced fetal movements (RFM) and small-for-gestational-age (SGA) birth at term and to explore if fetal and maternal outcomes are different with single vs repeated episodes of RFM and normal fetal assessment test results. This was a retrospective cohort study of all singleton pregnancies referred for RFMs at a tertiary fetal medicine unit from January 2008 through September 2014. Ultrasound and Doppler indices were obtained from a computerized ultrasound database and pregnancy outcome was collected from hospital records. Of the 21,944 women with a singleton pregnancy booked for maternity care during the study period, 1234 women (5.62%) reported RFMs >36+0 weeks. Of these, 1029 women (83.4%) reported a single episode of RFM and 205 (16.6%) had ≥2 presentations for RFM. Women with repeated RFMs had a significantly higher mean uterine artery pulsatility index in the second trimester. The prevalence of SGA baby at birth in women presenting with a single episode as compared to repeated episodes of RFM was 9.8% and 44.2%, respectively (odds ratio, 7.3; 95% confidence interval, 5.1-10.4; P < .05). Repeated episodes of RFMs at term are more likely to occur in women with high second-trimester uterine artery Doppler resistance indices and are strongly associated with the birth of SGA infants. Women presenting with repeated episodes of RFM should be treated as being at high risk of placental dysfunction irrespective of the results of prenatal ultrasound and Doppler assessment.

Role of the Glucose Tolerance Test as a Predictor of Preeclampsia

Objective: To determine whether oral glucose tolerance tests (OGTT) play a role as predictors of preeclampsia (PET) in pregnant women. Methods: A retrospective case-control study was conducted in 2,002 singleton pregnancies that had a uterine artery (UtA) Doppler at 22-25 weeks and an OGTT. The UtA Doppler and OGTT were adjusted based on maternal characteristics, and the results were expressed as multiples of the expected normal median and compared between groups. Logistic regression analysis was used to determine whether maternal characteristics, OGTT, and UtA Doppler significantly contribute to the prediction of early- (<34 weeks), intermediate- (34-37 weeks), or late-onset (>37 weeks) PET. The performance of the screening was determined by ROC curves. Results: Women who developed PET were characterized by an older maternal age, an increased body mass index, and an altered UtA Doppler. The group with intermediate-onset PET was the only one associated with higher 2-hour OGTT levels compared to controls. Combined models were developed via logistic regression analysis using maternal characteristics, UtA Doppler, and OGTT to predict PET. These combined models were able to detect around 74, 42, and 21% of women who later developed early-, intermediate-, or late-onset PET, respectively, with only a 5% false-positive rate. Conclusions: This study shows that the combination of maternal characteristics, second-trimester UtA Doppler, and OGTT is a predictor of the development of PET in healthy pregnant women.

Association between reduced fetal movements at term and abnormal uterine artery Doppler indices

To evaluate the association between second-trimester uterine artery (UtA) Doppler pulsatility index (PI) with reduced fetal movements (RFM) and adverse pregnancy outcome at term. This was a retrospective cohort study of all singleton pregnancies referred for routine antenatal care at a fetal medicine unit over a 5-year period. UtA Doppler indices were obtained at the time of the routine anomaly scan between 19 and 23 weeks' gestation to assess the risk for pre-eclampsia. All episodes of RFM within 1 month of the expected date of delivery were recorded. Regression and sensitivity analyses were used to assess the relationship between UtA-PI with RFM, small-for-gestational-age (SGA) fetuses and stillbirth after 36 weeks' gestation. Overall, 17, 649 pregnancies were included in the analysis, of which 742 presented with RFM, 1494 gave birth to an SGA newborn and 53 were complicated by stillbirth after 36 weeks' gestation. Logistic regression analysis showed a significant and independent association between UtA-PI and RFM (odds ratio (OR), 5.03 (95% CI, 4.21-6.01); P < 0.001), SGA (OR 2.41 (95% CI, 2.09-2.79); P < 0.001) and stillbirth (OR 1.55 (95% CI, 1.21-1.98); P< 0.001). The association between UtA-PI and SGA was significantly stronger in women presenting with RFM than in the rest of the cohort (P < 0.001). Similarly the association between UtA-PI and RFM was significantly stronger in those pregnancies complicated by stillbirth (P < 0.001). Compared with normal pregnancies, those complicated by RFM, SGA and stillbirth at term had higher UtA-PI at 19-23 weeks' gestation. These findings support the assertion that RFM at term is independently related to placental dysfunction and subsequent risk for SGA and stillbirth.