UtA PI Research Articles

A prospective study on first trimester prediction of ischemic placental diseases.

The objective of the study is to assess the predictive power of mean uterine artery pulsatility index (UtA PI), maternal serum placental growth factor (PlGF) and placenta associated plasma protein A levels for the development of ischemic placental diseases (IPD) in a cohort of unselected singleton pregnancies during the first trimester combined test period. A sample of 880 pregnancies was registered between September 2014 and January 2016. After routine examination for first trimester combined test, UtA PI was measured, and maternal serum was obtained and stored at -80 °C for PlGF assessment. Early-onset preeclampsia, late-onset preeclampsia and placental dysfunction-related fetal growth restriction were observed in 6 (0.7%), 17 (2.0%) and 27 (3.2%) cases, respectively. IPD requiring delivery before 34 weeks of gestation could be predicted with a sensitivity, specificity, positive predictive value and negative predictive value of 76.2%, 90.2%, 20.2% and 99.1%, respectively. A combination of UtA PI, placenta associated plasma protein A and PlGF was proven to be successful in the first trimester prediction of IPD, with the highest sensitivity in the subgroup who required delivery before 34 weeks of gestation. In reducing the number of pregnancies that should be followed-up, further studies for new biomarkers are needed. © 2017 John Wiley & Sons, Ltd.

DOPPLER VELOCIMETRY OF THE FETAL MIDDLE CEREBRAL ARTERY, UMBILICAL AND UTERINE ARTERES IN THE PREDICTION OF PROLONGED PREGNANCY AND THEIR EFFECT ON NEONATAL OUTCOME

Background: Although the increased fetal morbidity and mortality associated with post-term pregnancy has long been appreciated, most authors have studied gestational age as the alone contributing factor. The influence of other factors such as maternal age, parity, maternal smoking, fetal genders, birth weight and past history of post-term has not been adequately evaluated, Additionally, the accuracy of earlier studies is limited by the fact that they predate the widespread use of both ultrasonography for accurate gestational dating and intensive fetal testing to establish fetal wellbeing. Objective: the present study was conducted to evaluate the effects of prolonged exceeding 287 days of menstrual age on the Doppler flow velocity waveforms in the umbilical, middle cerebral and uterine arteries, and its impact on neonatal outcome to determine the best predictor of adverse outcome in post-term. Patients and Methods: The present study included 50 pregnant ladies All patients were submitted to ultrasound for detection of fetal genders, fetal weight and amniotic fluid index (AFI) Also, they were submitted to color Doppler velocimetery of fetoplacental and fetal vessels including middle cerebral pulsitility index MCA PI), umbilical artery pulsitility index UA PI), middle cerebral resistance index MCA RI), umbilical artery resistance index UA RI), uterine artery pulsitility index UtA PI),and uterine artery pulsitility index UtA RI). Results: In the present study, there was no statistical signification with gestational age, fetal heart rate and parity. The primary gravida had the highest incidence. There was higher rate of CS which was significant with prolongation of pregnancy, but with no statistically significant difference between adverse and normal outcome Also, the incidence of males was more than females in our population with no significant relation between fetal gender and neonatal outcome. Adverse outcome was associated with lower MCA PI, MCA RI, AFI, Apgar score, and higher UA RI compared to normal outcome with statistically significant difference between them, but there was no statistically significant difference as regard UA PI, UtA PI, UtA RI. Conclusion: The perinatal morbidity and mortality may be increase in post-term pregnancies. However, the all screening tests and Doppler indices may be normal due to mode of delivery, time of delivery, and type of anesthesia during labor. So, during labor, rapid interference should be taken to decrease incidence of adverse neonatal outcome. In post-term pregnancies with adverse outcomes, impedance to flow in umbilical arteries may be increased, while impedance to flow in the fetal middle cerebral arteries may be decreased, but impedance to flow in uterine arteries may be normal

Bedside cardiovascular maternal interrogation in the first trimester to predict different phenotypes of hypertensive disorders in pregnancy.

The aim is to evaluate if maternal cardiovascular indices, in the first trimester of pregnancy, might be useful to differentiate women who develop different hypertensive disorders of pregnancy (HDP). Method: 1399 pregnant women attending screening for chromosomal aneuploidies were recruited. The following parameters were measured: Doppler Velocimetry of uterine arteries; Peripheral blood pressure; Aortic Pressure derived from applanation tonometry. Primary outcome were: women who developed HDP associated with newborns with an appropriate weight for local gestational age standards (AGA) and women that developed HDP associated with a newborn weight below the 10th centile (SGA). Mean UtA PI was significantly higher in the HDP-SGA compared with controls. HDP-AGA showed a higher rate of family history of hypertension and a higher BMI. In HDP-AGA Brachial and Aortic mean pressure were higher than controls. The most significant contributors for all forms of HDP were mean UtA PI for HDP-SGA and mean arterial blood pressure for HDP-AGA. The multivariate logistic regression for HDP-SGA shows an AUC 0.88, whereas the AUC for the prediction of HDP-AGA group was 0.71. HDP-SGA were characterized by significantly higher values of UtA-PI, whereas HDP-AGA by mean aortic and brachial pressure and risk factors for endothelial dysfunction.

Is there a role for 3 dimensional power Doppler placental ultrasound and computerised assessment of calcification in post-term pregnancies?

PurposeTo assess if three dimensional power Doppler (3DPD) placental ultrasound, evaluating volume, vascularisation, and blood flow in post-term pregnancies differs from normal pre-term third trimester pregnancies and to examine whether computer analysis identifies the continual increase in calcification in post-term pregnancies. Materials and methodsA prospective cohort study of 50 women with post-term pregnancies (40 + 0 to 41 + 6 weeks) and 58 controls (36–40 weeks). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Calcification percentage was calculated, by computer analysis. Results were compared with previously determined normal values and correlated with uterine, middle cerebral and umbilical artery Doppler values and placental histology. ResultsPlacental volume, VI, FI and VFI are not influenced by GA beyond 40 weeks gestation and are similar between post-term and normal pregnancies (36–40 weeks). Placental volume decreased as the mean uterine artery pulsatility index (UtA PI) increased; p = 0.047. FI was reduced where chorangiosis was found at histology (p = 0.033). Computer analysis of placental calcification identified the increased calcification expected after 40 weeks, and showed that calcification continues to increase between 40 and 42 weeks (p = 0.029). ConclusionAlthough the sample size limits the generalisability of the findings, we found that calcification of the placenta continues to increase between 40 and 42 weeks gestation, that there is an association between an increasing UtA PI and a decreasing placental volume and that FI measurement may be useful in the identification of chorangiosis in post-term pregnancies.

Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium?

ObjectiveTo investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period.MethodsThe UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured.ResultsOne hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73).ConclusionThe UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

O113. Measurements of arterial stiffness and uterine artery Doppler for the prediction of preeclampsia in women presenting with gestational hypertension

Objective While gestational hypertension (GH) and chronic hypertension are usually benign, pre-eclampsia (PE) is more commonly associated with adverse maternal and fetal outcomes. About 15–25% of women initially diagnosed with GH will develop PE, but only 10% of women who develop GH after 36 weeks of gestation will develop PE. Pulse wave velocity (PWV) and augmentation index (AIx) are markers of arterial stiffness and endothelial dysfunction, while uterine artery Doppler pulsatility index (UtA PI) reflects the resistance in the uteroplacental circulation. These parameters have been shown to be associated with the risk of PE. The main aim of this study was to investigate whether maternal cardiovascular changes can discriminate pregnancies which will subsequently develop PE among those presenting with GH. Methods This was a prospective cohort study in women with singleton pregnancies presenting with GH at St George’s Hospital (n = 112). Another group of uncomplicated singleton pregnancies were recruited as controls. PWV, AIx and aortic systolic blood pressure (SBPAo) were recorded using the Arteriograph® (TensionMed Ltd., Budapest, Hungary). The uterine artery Doppler was recorded on both sides and the mean PI was calculated. Mann-Whitney and Chi-Square tests were used to compare the groups, while regression analysis was used to identify and adjust for potential confounders. The predictive accuracy for the development of PE was assessed using the ROC curve analysis. Results The analysis included 105 pregnancies with GH and 356 controls. Compared to the group that remained as GH (n = 82), the group that developed PE (n = 23) had significantly higher AIx (25.9%, IQR 12.8–34.3 vs 15.8%, IQR 6.1–25.6; p = 0.019) and SBPAo (141 mmHg, IQR 130–158 vs 130 mmHg, IQR 123–142; p = 0.005) at the initial assessment. They also had significantly higher UtA mean PI at 20–24 weeks (1.10, IQR 0.78–1.47 vs 0.83, IQR 0.68–1.04; p = 0.008). AIx was significantly associated with the risk of development of PE (odds ratio 1.05; 95% CI 1.01–1.09, p = 0.016). For a cut-off of 31.18%, AIx had sensitivity of 41.2% (95% CI 18.4–67.1%) and specificity of 93.2% (95% CI 83.5–98.1%) and LR 6.07 (AUC 0.69; 95% CI 0.53–0.84, p = 0.019). Conclusion Arterial stiffness and SBPAo measured at the initial assessment of GH can potentially discriminate the pregnancies that will develop PE. Identification of women who will develop PE among those who initially present with PIH is likely to facilitate targeted antenatal surveillance and possibly intervention.

PFM.15 Is there a role for Placental Volume, Vasculature and Calcification in monitoring Post-term Pregnancies?

ObjectivesThis study aims to assess if three dimensional power Doppler (3DPD) ultrasound of the placenta, evaluating placental volume, vascularisation, and blood flow in post-term pregnancies differs from normal. It also...

Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)

Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation) to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.

Blood flow to the scarred gravid uterus at 22–24 weeks of gestation

To compare uterine artery volume blood flow (Q(uta)), vascular resistance (R(uta)), pulsatility index (Uta PI), and the fraction of maternal cardiac output (CO) distributed to the uteroplacental circulation in pregnant women with and without a previous caesarean section. Cross-sectional observational study. University hospital in Norway. Thirty-two pregnant women with previous caesarean section and 32 matched controls. Ultrasonography was used to measure uterine artery diameter and blood flow velocity between 22(+0) and 23(+6) weeks of gestation. Impedance cardiography was used to assess maternal haemodynamics. Q(uta), R(uta), Uta PI, and the fraction of maternal CO distributed to the uteroplacental circulation. The mean Q(uta) was 356.26 ± 213.72 ml/minute in cases and 456.41 ± 209.70 ml/minute in controls (P = 0.038). R(uta) was significantly (P = 0.026) higher among cases compared with controls (0.32 ± 0.20 versus 0.22 ± 0.14 mmHg/ml/minute), but the Uta PI did not differ between the groups (0.93 ± 0.23 versus 0.92 ± 0.47; P = 0.929). The fraction of maternal CO distributed to the uteroplacental circulation was 5.75 ± 3.68% in cases and 8.45 ± 5.02% in controls (P = 0.014). Uterine artery volume blood flow and the fraction of maternal cardiac output distributed to the uteroplacental circulation are lower, and uterine vascular resistance (but not Uta PI) is higher, in women with previous caesarean section compared with the control group.

Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy

The aim of this study is to validate the Fetal Medicine Foundation (FMF) multiple logistic regression algorithm for prediction of risk of pre-eclampsia in an Australian population. This model, which predicts risk using the population rate of pre-eclampsia, a variety of demographic factors, mean maternal arterial blood pressure (MAP), uterine artery PI (UtA PI) and pregnancy-associated plasma protein A (PAPP-A), has been shown to predict early-onset pre-eclampsia (delivery prior to 34weeks) in 95% of women at a 10% false-positive rate. All women who attended first trimester screening at the Royal Prince Alfred Hospital had their body mass index (BMI), MAP and UtA PI assessed in addition to factors traditionally used to assess aneuploidy (including PAPP-A MoM). After delivery, risks of early-onset (delivery prior to 34weeks) pre-eclampsia, late pre-eclampsia and gestational hypertension were calculated using the FMF risk algorithm. A total of 3099 women were screened and delivered locally. 3066 (98.9%) women had all data to perform pre-eclampsia screening available. This included 3014 (98.3%) women with a live birth, where risks of early pre-eclampsia were calculated. Twelve women were delivered before 34weeks because of early pre-eclampsia with a prevalence of early pre-eclampsia of 1 in 256 pregnancies. Risks generated through the use of maternal history, MAP, UtA PI and PAPP-A detected 41.7 and 91.7% of early pre-eclampsia at a false-positive rate of 5 and 10%, respectively. This study shows that the FMF early pre-eclampsia algorithm is effective in an Australian population.

First and second trimester screening for large for gestational age infants

Objectives: To find the best early predictor model for fetal growth and large for gestational age (LGA) infants considering clinical, ultrasonographic and biochemical variables.Method: In 2097 singleton pregnancies at first trimester, we evaluated maternal characteristics, PAPP-A and ß-HCG proteins, fetal nuchal translucency thickness and uterine artery pulsatility index (UtA-PI). At second trimester fetal ultrasound biometry and UtA-PI were then measured. The relationships between birth weight and LGA and maternal characteristics, first and second trimester variables, and all variables combined, were studied. The performance of screening was determined by receiver operating characteristic curves analysis.Results: Stepwise regression analysis showed that in the prediction of birthweight percentile there were significant contributions from all maternal factors, PAPP-A and Ut-A PI in the first trimester, and fetal biometric variables in the second trimester. Maternal charateristics combined with PAPP-A, β-hCG, fetal NT and uterine artery PI identified 30.2 % LGA (FPR 10%). The combined model reached a sensitivity of 41.2% (FPR 10%) and 56.2% (FPR 20%).Conclusions: Sensitivity of the screening for LGA improves significantly after addition of second trimester ultrasound measurements to first trimester variables and maternal characteristics.

PP055. Uric acid correlates with uterine artery vascular resistance, but not with uterine artery pulsatility index

Studies indicate that uric acid is involved in the development of hypertensive diseases of pregnancy, and that uric acid might influence the remodeling of the spiral arteries. To investigate the relationship with uric acid and utero-placental hemodynamics in the second half of pregnancy. 53 women with uncomplicated pregnancies were examined longitudinally at 4-weekly intervals from 22 to 40 weeks of gestation. Blood samples for plasma uric acid were analyzed (enzymatic colorimetric method. Modular P, Roche Diagnostic), and blood pressure (BP) was measured. Uterine artery Doppler velocity waveforms were obtained, and vessel diameter was measured bilaterally. Uterine artery volume blood flow (Quta) was calculated as the product of mean velocity and cross-sectional area of the vessel. Mean arterial pressure (MAP) was calculated as: diastolic BP+(systolic BP - diastolic BP)/3. Uterine artery resistance (Rquta) was calculated as: MAP/Quta. Uterine artery pulsatility index (UtaPI) was calculated as: (peak systolic velocity - end-diastolic velocity)/time-averaged maximum velocity. Linear mixed models and linear regression models were used for statistical analysis. 242 blood samples were analyzed. Uric acid increased from 176 to 238μmol/L. Rquta and UtaPI decreased from 0.26 to 0.13mmHg/ml/min and 0.8-0.6 respectively. Uric acid was significantly correlated to Rquta (p=0.005), but not to Uta PI (p=0.178). There is a strong association between uric acid and uterine artery vascular resistance during the second half of pregnancy indicating that uric acid might play a role in establishing low resistance blood flow in the uteroplacental compartment.

Third trimester abdominal circumference, estimated fetal weight and uterine artery doppler for the identification of newborns small and large for gestational age

To understand if ultrasound biometric evaluation at 30-32 weeks of gestation is a valuable screening tool for the detection of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants at birth in a low risk population. We enrolled 1848 pregnant women with singleton pregnancy undergoing routine fetal biometry. We divided the infants into four groups: moderate SGA, severe SGA, moderate LGA and severe LGA. We considered third-trimester estimated fetal weight (EFW), abdominal circumference (AC), EFW centile (EFWc), AC centile (ACc) and compared their prediction toward SGA and LGA to determine which of these parameters was the best estimator for fetal size. Then we took the strongest predictive value and added all history-related and ultrasound factors to run a stepdown multivariate logistic regression. All the variables were then dichotomized and sensitivity models only for statistically significant parameters were calculated. We identified the following predictive factors for each outcome: for severe SGA: EFWc with p<0.001, uterine artery pulsatility index (UtA PI) with p<0.002. For moderate SGA: EFWc with p<0.001, UtA PI with p<0.004, maternal preeclampsia p<0.002. For moderate and severe LGA: EFWc with p<0.001. We can detect in a low-risk population a group at risk of growth deviations. Adding Doppler velocimetry to 30-32 weeks EFWc improves the specificity (84%) regarding SGA newborns, maintaining a good sensitivity (71%), and reducing the population to be re-screened from 27 to 17%. An ultrasound examination at 34-36 weeks or the clinical assessment of maternal risk factors remain the best tools for LGA newborns.

OP09.08: Triple vascular test for prediction of pre-eclampsia

Objectives: Uterine Doppler is used in screening for placentaassociated diseases, such as pre-eclampsia and intrauterine growth restriction of the fetus (IUGR). The aim of this study was to examine the predictive value of second trimester uterine Doppler in pregnancies complicated by systemic lupus eritematosus (SLE). Methods: Observational study on 55 pregnancies in women with SLE treated at our Unit from 2000 to 2008. The Doppler examination was performed between 23+0 and 25+6 weeks of gestation. The mean uterine artery pulsatility index (UtA PI) was calculated. Results: The median (interquartile range, IQR) UtA PI was 1.00 (0.90–1.20). Three patients had a mean uterine artery PI above the 95th centile for gestational age. All these patients developed pre-eclampsia and IUGR. No cases of pre-eclampsia or IUGR were observed in patients with the mean uterine artery PI below the 95th centile for gestational age. The sensitivity was 100% (95% CI 0.44–1.00), specificity was 100% (95% CI 0.93–1.00). Conclusions: In our series, the mean uterine artery PI was an excellent predictor for pre-eclampsia and IUGR in women with SLE.

PP173. The role of mean artery blood pressure in the prediction of pre-eclampsia in pregnancies complicated with chronic hypertension

Chronic hypertension (CH) is a common disorder occurring in approximately 1-5% of pregnant women. Many studies emphasize that the development of superimposed preeclampsia (PE) is associated with high rates of adverse pregnancy outcome. Accurate prediction of women at risk for PE is crucial to judicious allocation of monitoring resources and use of preventive treatment, in order to improve maternal and neonatal outcome. Recent systematic review and meta-analysis showed that mean arterial pressure (MAP) is a better predictor for pre-eclampsia than systolic blood pressure and diastolic blood pressure To detect the value of MAP in the first and second trimesters to predict PE in women with CH. To determine if MAP, assessed in the second trimester, can increase the predictive value for PE of II trimester UtA PI. Cohort study on 100 consecutive singleton pregnancies complicated with CH referred to our Department from January 2008 to June 2011. Blood pressure was measured by a mercury sphygmomanometer at 11-14+6w and 23+0-25+6w, MAP was calculated. Doppler-velocimetry was performed at 23+0-25+6w, mean UtA PI was calculated. PE and CH were defined according to ISSHP criteria. Clinical and perinatal outcomes were reviewed. Receiver-operating characteristic (ROC) curves were used to determine the predictive ability of I and II trimesters MAP and II trimester mean UtA PI for subsequent development of PE. Logistic regression analysis was run to assess the additional value of II trimester MAP to II trimester UtA PI. Mean maternal age was 36 years (SD ±5yy); mean Body mass Index was 24Kg/mq (SD ±5Kg/mq); GA at I Trimester evaluation was 11+4w (SD ±1+5w); I trimester MAP was 100.46mmHg (mean, SD ±9.94mmHg); GA at Doppler and II trimester MAP was 24+4w (SD ±4dd); II trimester MAP 97.53mmHg (mean, SD ±10.27mmHg). Nineteen cases of PE were observed. Seventy patients were under prophylactic ASA 100mg oid. Fifty-two patients were under anti-hypertensive therapy from the first trimester. No differences in prevalence of PE were observed between patients in and out prophylactic treatment, as well as no differences in prevalence of PE were observed between patients under anti-hypertensive treatment or not. The prediction of subsequent development of PE, expressed as the area under ROC curve, was 0.469 (95% CI 0.34-0.59) for I trimester MAP; 0.659 (95% CI 0.55-0.76) for II trimester MAP; 0.748 (95% CI 0.65-0.83) for II trimester mean UtA PI; GA at delivery was 37+4w(mean, SD ±3+2w); mean BW was 2958g (SD ±735g); BW percentile was 38 (mean SD ±29 percentiles); mean BW z-Score was -0.63 (SD ±1.6). Logistic regression analysis showed that MAP does not increase the predictive ability of II trimester UtA PI in women with CH. In our findings, MAP seems not to be a good predictor for subsequent development of PE in women with CH, moreover, it seems to be not useful to increase the predictive value for PE of II trimester UtA PI. II trimester UtA PI has been confirmed to be the best predictor for subsequent development of PE.

First trimester maternal serum PIGF, free β-hCG, PAPP-A, PP-13, uterine artery Doppler and maternal history for the prediction of preeclampsia

ObjectiveTo evaluate the detection of pregnancy hypertensive disorders by integrating maternal history, serum biomarkers and uterine artery Doppler in the first trimester. MethodsWe prospectively recruited 2118 women that underwent an 11–13 weeks aneuploidy screening. We gathered information on maternal history, uterine artery Doppler and serum biomarkers (PAPP-A, PlGF, PP-13 and free β-hCG). Models were developed for the prediction of overall preeclampsia (PE), early-onset PE, late-onset PE and gestational hypertension (GH). For each outcome, we performed a multivariate logistic regression starting from the saturated model: adopting a step-down procedure we excluded all factors not statistically significant (p > 0.05). Sensitivity models only for statistically significant parameters were calculated from the ROC curves for fixed false-positive rates (FPR). ResultsAmong 2118 women, 46 (2.17%) developed GH and 25 (1.18%) were diagnosed with PE, including 12 (0.57%) early-onset PE and 13 (0.61%) late-onset PE. For a fixed FPR of 10 and 5%, serum PlGF, free β-hCG and chronic hypertension identified respectively 67 and 75% of women who developed early-onset PE. In the model for the prediction of overall PE the combination of the uterine artery Doppler pulsatility index (UtA PI) with PlGF and chronic hypertension reached a sensitivity of 60% for a 20% of FPR. ConclusionAn integration of maternal characteristics and first trimester maternal serum biomarkers (free β-hCG and PlGF) provided a possible screening for early-onset PE. In the overall PE model, UtA PI turned out to be statistically significant but did not improve the detection rate.

391: Maternal and fetal Doppler pulsatility indices predict adverse pregnancy outcome in uncomplicated pregnancies with borderline-low amniotic fluid index in the early third trimester

indices predict adverse pregnancy outcome in uncomplicated pregnancies with borderline-low amniotic fluid index in the early third trimester Kazumasa Hashimoto, Tania Kasdaglis, Sheveta Jain, Ozhan Turan, Kristin Atkins, Jerome Kopelman, Chris Harman, Ahmet Baschat University of Maryland School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, University of Maryland School of Medicine, Obstetrics & Gynecology and Reproductive Sciences, Baltimore, MD OBJECTIVE: We have reported borderline-low (BL) amniotic fluid index (AFI) in the early third trimester in uncomplicated pregnancy associated with adverse outcome. The aim of this study is to test if maternal and/or fetal Doppler indices can stratify risks of adverse perinatal outcome. STUDY DESIGN: Nested case-control study in cohort of uncomplicated pregnancy with BL-AFI (8.0-11.9) at 28.0-31.9 weeks gestation (20062010, N 173). Frequency of abnormal uterine artery Doppler pulsatility index (UtA PI), umbilical artery (UA PI) and middle cerebral artery (MCA PI) were compared between controls and those with adverse outcome, defined in categories: Antepartum (abnormal antepartum testing, stillbirth, placental abruption, preeclampsia, N 9), Delivery (emergency and/or fetal-indicated Cesarean delivery, preterm birth, N 52), Neonatal (birth weight 1.645 (90th centile) for UA PI and UtA PI, and Z-score 1.645 (10th centile) for MCA PI, defined abnormal values. RESULTS: Abnormal UtA, UA, and MCA-PI were significantly more common in all categories of adverse outcome, compared to controls. When any Doppler index is abnormal, prediction of adverse outcome had the following characteristics: Antepartum sensitivity (SN 0.88), specificity (SP 0.80), positive predictive value (PPV 0.26) and negative predictive value (NPV 0.99); Delivery (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Neonatal (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Composite (SN 0.39, SP 0.85, PPV 0.63, NPV 0.67). While individual Doppler indices had clinically-low predictive ability, combining UtA, UA, and MCA PI increases SN and NPV. CONCLUSION: Using these parameters, maternal and fetal Dopplers can identify cases at high-risk for adverse outcome in uncomplicated patients with borderline AFI. Measurement of all three Doppler indices helps triage such pregnancies.