Uterine Artery Doppler Ultrasonography Research Articles

Neonatal outcome among High Risk Pregnant Women depending on the ratio of Fetal Cerebroplacental Artery versus Uterine Artery Doppler Ultrasonography

Neonatal outcome among High Risk Pregnant Women depending on the ratio of Fetal Cerebroplacental Artery versus Uterine Artery Doppler Ultrasonography

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

The Effect of Active and Passive Maternal Smoking During Pregnancy on the Uterine Artery Blood Flow and Obstetric Outcomes: A Prospective Study.

Maternal smoking is associated with an increased risk of obstetric and neonatal complications during pregnancy. We aimed to investigate the effects of active and passive smoking on fetal-maternal blood flow and fetal complications in mid-trimester pregnant women. This prospective study was conducted at Zekai Tahir Burak Women's Research and Training Hospital and included women who were 20 to 22 weeks old, with no fetal anomalies, and with a singleton pregnancy. The data used in the analysis were obtained from a total of 168 pregnant women (50 smokers, 50 passive smokers, and 68 non-smokers). Starting from their 20th week of pregnancy, the women were examined at least once in each trimester. Fetal and maternal pregnancy results were evaluated. Fetal biometry, umbilical, and uterine artery Doppler ultrasonography were performed. To evaluate the flow in these veins, the pulsatility index, resistance index, and systole/diastole (S/D) ratio were performed. The mean age of study patients was 25.06 ± 4.36 years and the mean gestational week was 20.03 ± 0.6 weeks. In terms of the umbilical artery pulsatility index (UMBAPI), umbilical artery systolic/diastolic ratio (UMBAS/D),uterine artery resistance index (UARI), uterine artery pulsatility index (UAPI), and uterine artery systolic/diastolic ratio (UAS/D) levels, the mean value of the smoker group was significantly higher compared to the non-smoker group (p<0.001, p=0.043, p=0.021, p=0.020, and p=0.037, respectively). The birth weight of the fetus was significantly lower in the active and passive smoker groups than in the non-smoker group (p=0.009 and p=0.006, respectively). The number of patients diagnosed with intrauterine growth restriction (IUGR) and oligohydramnios were significantly higher in the smoker group than in the passive smoker and non-smoker groups (p=0.003 and p<0.001, respectively). The risk of low birth weight (OR, (95% CI): 3.38 (2.05 - 5.57); p=0.024), oligohydramnios (OR (95% CI): 13.44 (5.22 - 34.57); p=0.001), IUGR (OR (95% CI): 9.33 (4.50 - 19.33); p=0.001), and preterm birth (OR (95% CI): 4.56 (1.25 - 17.32); p=0.001) increased significantly in the active and passive cigarette exposure groups, compared to the non-smokers. During pregnancy, both smoking and passive exposure to cigarette smoke adversely affect the fetus and the newborn. Uterine and umbilical artery Doppler measurements in pregnant women who smoke are significantly higher than the pregnant women who do not smoke.

Uterine Artery Doppler Velocimetry in the Prediction of Pre-Eclampsia

A major goal towards improving antenatal management of pre-eclampsia is to develop accurate prediction model that identifies women at high risk of this disease for appropriate interventions. The objective of this study was to evaluate the usefulness of uterine artery Doppler screening at 18-20 weeks gestation in predicting the development of preeclampsia. This study involved 100 healthy pregnant women between the gestational ages of 18-20 weeks with singleton fetus recruited from the antenatal care clinic. All the women had uterine artery Doppler ultrasonography done. Abnormal results were defined as systolic/diastolic (S/D) ratio, resistivity index &gt; 95th centile and the presence of a uterine artery diastolic notch. All participants were followed up till delivery and outcome measure (development of preeclampsia) was obtained from antenatal records. The statistical significance level was set at P &lt; 0.05. There was significant association between an abnormal uterine artery S/D ratio (χ2 = 9.34, P = 0.02), uterine artery R.I (χ2 = 9.53, P = 0.02), uterine artery diastolic notch (χ2 = 13.46, P = 0.01), and the combined uterine artery indices (χ2 = 14.26, P = 0.001) with subsequent development of Preeclampsia. It was concluded that abnormal uterine artery Doppler indices were associated with development of Preeclampsia and may be considered as a tool to be used in screening for Preeclampsia.

Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.&#x0D; Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables.&#x0D; Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively.&#x0D; Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.

Uterine Artery Doppler Ultrasonography for First Trimester Prediction of Preeclampsia in Individuals at Risk from Low-Resource Settings.

Background and objectives: The objective of this study was to evaluate the potential of first trimester uterine artery Doppler ultrasonography for the early prediction of preeclampsia (PE), in at-risk pregnant women. Materials and Methods: This was a prospective longitudinal study, including 120 Caucasian pregnant women with risk factors for PE. The potential of pulsatility indexes (PI) and notch was assessed as a tool for preeclampsia screening. Results: Doppler examination of the uterine artery performed early at 11–14 WA allows the detection of pregnancies that will develop PE with a sensitivity of 61.5% and a specificity of 63.8% based on PI analysis. Predictive power increases slightly by adding bilateral notch (sensitivity = 65.4%; specificity = 66%). Conclusions: Uterine artery Doppler examination is an effective non-invasive screening test for the development of PE in pregnancies at risk, particularly appropriate in health systems with limited means of evaluating other biomarkers.

ارزیابی نقش مارکرهای سرمی و سونوگرافی داپلر شریان رحمی در پیشگویی پره‌اکلامپسی در سه ماهه دوم بارداری: یک مطالعه مرور سیستماتیک

مقدمه: پره­اکلامپسی، شایع‌ترین عارضه طبی در بارداری است. با توجه به پاتوفیزیولوژی و اتیولوژی پیچیده پره‌اکلامپسی، طیف وسیعی از مارکرها بررسی شده‌اند که علاوه بر ارزش پیشگویی، شناسایی این عوامل ممکن است مکانیسم روشنی برای پاتوژنز پره­اکلامپسی فراهم کند. مطالعه مروری حاضر با هدف ارزیابی نقش چهار مارکر سرمی و سونوگرافی داپلر شریان رحمی در پیشگویی پره­اکلامپسی در سه ماهه دوم بارداری انجام شد. روش‌کار: در این مطالعه مروری جهت یافتن مطالعات مرتبط، در بازه زمانی 2000 تا 2017 از پایگاه­های اطلاعاتی SID، Weily online library،Elsevier ، Scopus، Pubmed و همچنین موتور جستجوی Google Scholar استفاده شد. برای دستیابی به تمامی مقالات به زبان انگلیسی و فارسی مورد نظر از کلید واژه­های فارسی شامل: BHCG، اینهیبین A، اکتیوین A، آلفا فتوپروتئین، مارکرهای سرمی، سونوگرافی داپلر شریان رحمی، سه ماهه دوم و پیشگویی پره­اکلامپسی و کلید واژه­های انگلیسی شامل: serum markers،Uterine artery Doppler ultrasonography، Preeclampsia prediction، Second trimester، AFP، β-HCG، Activin A، Inhibin A با همه ترکیبات احتمالی این کلمات استفاده شد. یافته‌ها: نتایج مطالعات مختلف بیانگر این مسئله بودند که هیچ یک مارکرهای مورد مطالعه شامل اکتیوین A و اینهیبین A، β-HCG و AFP به تنهایی قدرت پیشگویی پره­اکلامپسی را با حساسیت و ویژگی بالا فراهم نمی‌کنند، اما سونوگرافی داپلر شریان رحمی در سه ماهه دوم بارداری را می­توان به عنوان یک تست غربالگری برای پیشگویی پره­اکلامپسی در زنان پرخطر به‌کار برد. نتیجه‌گیری: مهم‌ترین استراتژی‌های پیشگویی پره‌اکلامپسی شامل: مشخصات فردی، سونوگرافی شریان داپلر و بیومارکرها می­باشند و هیچ‌یک از این مارکرها به تنهایی قدرت پیشگویی پره­اکلامپسی را با حساسیت و ویژگی بالا فراهم نمی‌کنند.

The Study of Predictive Value of Uterine Artery Doppler in Incidence of Preeclampsia and Intrauterine Growth Restrictions in Pregnant Women

Objectives: Preeclampsia is considered as one of the most important causes of death among pregnant women all around the world. This study aimed to study the predictive value of uterine artery Doppler ultrasonography in the incidence of preeclampsia and the intrauterine growth restriction (IUGR) in pregnant women who attended Fatemieh hospital. Materials and Methods: This study was performed by the prospective cohort method and the statistical population included 108 pregnant women, in their 18-22 weeks of pregnancy, with a singleton pregnancy who referred to the prenatal Fatemieh Hospital of Hamadan during 2013-2016. The uterine artery Doppler ultrasonography was performed and the incidence of IUGR and the occurrence of preeclampsia in the followed pregnancy was evaluated in these patients. Data were analyzed by SPSS 16.0 using the chi-square and Mann-Whitney U statistical tests. Results: The mean difference of pulsatility index (PI) in patients with preeclampsia was statistically significant compared to healthy individuals (P=0.001). In addition, the mean difference of PI in individuals with infants suffering from IUGR was statistically significant compared with the infants not suffering from the IUGR (P=0.001). Further, the incidence of preeclampsia and IUGR in women with a bilateral notch in ultrasonography was significantly greater than those of the women with no report of a bilateral notch in ultrasonography (P=0.001). Conclusions: Therefore, Doppler ultrasonography of the uterine artery has a predictive value in preeclampsia among pregnant women.

Angiogenesis Factors and Uterine Artery Doppler Ultrasound Resistance Index and Pulsatility Index in Pregnancies with High-Risk of Preeclampsia

Background: Endothelial dysfunction in the maternal circulation is an early finding during preeclampsia. Early diagnosis is very important to protect from maternal and neonatal morbidity we aimed to investigate the Vascular Endothelial Growth Factor (VEGF), anti-angiogenic VEGFR-1 (sVEGFR-1) or soluble FMS-like tyrosine kinase-1 (sFlt-1), and angiogenic PlGF using uterine artery Doppler ultrasonography and to evaluate placental vascular and fetomaternal blood flow changes.Methods: This cross-sectional study included a total of 64 pregnant women aged between 15 and 40 years who were in their 20 to 24 weeks of gestation and who were at a risk of developing preeclampsia. The patients were reexamined after delivery and divided into two groups according to those who developed preeclampsia/IUGR (n=9/7) and those who did not (n=48). We compared the VEGF, sFlt1 and PlGF using uterine artery Doppler ultrasonography changes.Results: Univariate analysis results of potential factors for preeclampsia were insignificant except age (p=0.047) and body mass index (0.004). In our ROC curve, the pvalue was found to be significant.Conclusion: Our study results demonstrated that biochemical and radiologic markers did not give any clues for early diagnosis at the 20 to 24 weeks of gestation.

A quantitative investigation of hemodynamic adaptation to pregnancy using uterine artery Doppler ultrasonography and finger photoplethysmography

Objective: Normal pregnancy is characterized by maternal hemodynamic adaptations of cardiovascular system and uterine artery. We aimed to investigate quantitatively the relationship between uterine artery Doppler (Ut AD) ultrasonography and finger photoplethysmography (PPG) in each of the three trimesters. Methods: Eighty normal pregnancy subjects were recruited from the nulliparous women with uncomplicated singleton pregnancy presenting for a routine ultrasound scan and divided into three groups according to their trimester. Comparative analysis were conducted between Ut AD ultrasonography and finger PPG within and across trimesters, particularly with focus on the relationship between Uterine Artery Resistance Index (UtA RI) and photoplethysmographic reflection index (PPG RI) throughout pregnancy. Additional 10 preeclampsia patients in third trimester were enrolled for comparison. Results: Both UtA RI and PPG RI were markedly decreased with gestation in normal pregnancy and generally consistent with each other in trend. The preeclampsia patients of third trimester were significantly higher in both indices, even more than normal pregnancy subjects of first trimester. Conclusions: The results of this study revealed clear relationship between UtA RI and PPG RI throughout pregnancy which could be exploited to enhance the potential ability in early recognition of pathophysiologic process in maternal adaptation and prediction of complicated pregnancy.

Screening models using multiple markers for early detection of late-onset preeclampsia in low-risk pregnancy

BackgroundOur primary objective was to establish a cutoff value for the soluble fms-like tyrosine kinase 1(sFlt-1)/placental growth factor (PlGF) ratio measured using the Elecsys assay to predict late-onset preeclampsia in low-risk pregnancies. Our secondary objective was to evaluate the ability of combination models using Elecsys data, second trimester uterine artery (UtA) Doppler ultrasonography measurements, and the serum fetoplacental protein levels used for Down’s syndrome screening, to predict preeclampsia.MethodsThis prospective cohort study included 262 pregnant women with a low risk of preeclampsia. Plasma levels of pregnancy-associated plasma protein-A (PAPP-A) and serum levels of alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin-A were measured, and sFlt-1/PlGF ratios were calculated. All women underwent UtA Doppler ultrasonography at 20 to 24 weeks of gestation.ResultsEight of the 262 women (3.0%) developed late-onset preeclampsia. Receiver operating characteristic curve analysis showed that the third trimester sFlt-1/PlGF ratio yielded the best detection rate (DR) for preeclampsia at a fixed false-positive rate (FPR) of 10%, followed by the second trimester sFlt-1/PlGF ratio, sFlt-1 level, and PlGF level. Binary logistic regression analysis was used to determine the five best combination models for early detection of late-onset preeclampsia. The combination of the PAPP-A level and the second trimester sFlt-1/PlGF ratio yielded a DR of 87.5% at a fixed FPR of 5%, the combination of second and third trimester sFlt-1/PlGF ratios yielded a DR of 87.5% at a fixed FPR of 10%, the combination of body mass index and the second trimester sFlt-1 level yielded a DR of 87.5% at a fixed FPR of 10%, the combination of the PAPP-A and inhibin-A levels yielded a DR of 50% at a fixed FPR of 10%, and the combination of the PAPP-A level and the third trimester sFlt-1/PlGF ratio yielded a DR of 62.5% at a fixed FPR of 10%.ConclusionsThe combination of the PAPP-A level and the second trimester sFlt-1/PlGF ratio, and the combination of the second trimester sFlt-1 level with body mass index, were better predictors of late-onset preeclampsia than any individual marker.

The outcomes and benefits of hysteroscopic procedures in women with recurrent implantation failure (RIF) after in vitro fertilization (IVF)

OBJECTIVE: Our goal is to present the first clinical pregnancy following uterus transplantation. DESIGN: Case report. MATERIALS AND METHODS: In 2011,uterus allotransplantation was performed in a patient with complete mullerian agenesis from a deceased donor.Eight embryos were vitrified before the transplantation procedure. Embryo transfer was planned following confirmation of graft stability and safe serum immunosuppressive levels. RESULTS: Immunosuppressive and infection prophylaxis therapies were started. Bilateral uterine artery doppler ultrasonography, cervical and endometrial biopsies demontrated no signs of thromboses or rejection. Starting from first month, the patient had menstrual bleeding with almost every cycle. Eighteen months after uterus allotransplantation and confirmation of the graft stability, one thawed embryo was transferred to the allotransplanted uterus. Serum human chorionic gonadotrophin levels and transvaginal ultrasonography confirmed a viable intrauterine pregnancy. CONCLUSION: Experimental animal and human research are promising to show allo uterus transplantation might be an alternative for fertility restoration.

Prediction of Preeclampsia by Combining Serum Histidine-Rich Glycoprotein and Uterine Artery Doppler

Preeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia. A total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14. HRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia. The combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18-22-week period of gestation. This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40mg) from the beginning of pregnancy until 36weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18-22-weeks period of gestation. No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07±0.46 for LMWH group and 0.91±0.31 for control, p=0.036) and the mean RI (0.59±0.12 for LMWH group and 0.54±0.10 for control, p=0.021) were significantly higher in the trombophilia group. Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.

Mid-trimester uterine artery Doppler ultrasound as a predictor of adverse obstetric outcome in high-risk pregnancy

Objective The aim of this study was to assess uterine artery Doppler ultrasonography efficiency in prediction of adverse pregnancy outcome in high-risk pregnancies. Materials and Methods We selected 70 pregnant women who were high risk for development of preeclampsia, abruption, low birth weight (LBW), and preterm delivery during their pregnancy, and Doppler ultrasonography was performed for them in 18–24 gestational weeks for evaluation of uterine artery notching. Absence of diastolic flow in uterine artery waves was defined as notching. The women were divided into two groups: with notching (Group A) and without notching (Group B), then they were compared for complications such as preeclampsia, abruption, LBW, and preterm delivery. Results In 70 high-risk pregnant women, 27 women (39.2%) were in Group A and the others were in Group B. The birth weight in Groups A and B was 2,897.5 ± 757.15 and 3,248.39 ± 374.27, respectively. In our study, 15 patients were delivered before 37 gestational weeks (preterm labor). Preeclampsia, abruption, and LBW were significantly higher in the group with positive notching, but preterm delivery did not show any statistical difference between the two groups. Conclusion According to the results, uterine artery Doppler ultrasonography had high negative predictive value for prediction of preeclampsia, abruption, and LBW. Therefore, absence of uterine artery notching in mid-trimester evaluation of high-risk pregnant women may predict better pregnancy outcome. We recommend Doppler ultrasonography for all high-risk pregnant women in second trimester for prediction of pregnancy outcome.

Angiogenic proteins and adipocytokines as markers for prediction of preeclampsia

Preeclampsia is characterized by the onset of high blood pressure and proteinuria in pregnancy, leading to substantial maternal and neonatal morbidity and mortality. It involves abnormal remodeling of the placental bed vasculature, placental ischemia and endothelial cell dysfunction. Defective placental development might reflect alterations in the levels of various biological markers. Affected patients show remarkable imbalances of angiogenic factors, including PlGF, soluble FMS-like tyrosine kinase 1, soluble endoglin and angiopoietin-2; these factors could therefore be potential markers for predicting preeclampsia with or without uterine artery Doppler ultrasonography. However, use of these markers to predict preeclampsia has yet to achieve the positive and negative likelihood ratios necessary if they are to be used in clinical practice. Large-scale studies using known markers are likely to identify suitable candidates that will enable greatly improved perinatal care, including prevention and better out...

Use of Doppler ultrasonography to predict pre-eclampsia

We enjoyed Jeltsje Cnossen and colleagues' systematic review of the use of uterine artery Doppler ultrasonography to predict pre-eclampsia.[1][1] They concluded that an increased pulsatility index with notching during the second trimester is the best predictor of pre-eclampsia and strongly

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis.

Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. We identified 74 studies of pre-eclampsia (total 79,547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients. Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests.

How useful is uterine artery Doppler ultrasonography in predicting pre-eclampsia and intrauterine growth restriction?

Pre-eclampsia and intrauterine growth restriction remain important causes of maternal and neonatal complications and death.[1][1]–[3][2] These 2 conditions are felt to be the result of abnormal placenta formation involving abnormal trophoblast invasion of spiral arteries and a reduction in

Prediction of pre‐eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy‐associated plasma protein‐A, free β‐human chorionic gonadotropin, activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation

To investigate the potential value of combining uterine artery Doppler ultrasonography with the measurement of maternal serum pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (beta-hCG), activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation, in the prediction of pregnancies that subsequently develop pre-eclampsia. The maternal serum PAPP-A, free beta-hCG, activin A and inhibin A concentrations at 22 + 0 to 24 + 6 weeks' gestation were measured in samples obtained from women with singleton pregnancies who participated in a screening study for pre-eclampsia by transvaginal color flow Doppler measurement of the uterine artery pulsatility index (PI). A search was made of the database to identify those who subsequently developed pre-eclampsia (n = 24) and a group of controls with normal outcome (n = 144). Regression analysis was performed to establish any relationship between the biochemical markers themselves and between the biochemical markers and uterine artery mean PI. A multivariate Gaussian model combining various biochemical markers with uterine artery mean PI was developed using standard statistical modeling techniques and the performance of such models in discriminating cases with pre-eclampsia was evaluated by receiver-operating characteristics curve (ROC) analysis. In the pre-eclampsia group, compared to the controls, the uterine artery mean PI and the maternal serum levels of PAPP-A, free beta-hCG, activin A and inhibin A were significantly increased. The predicted detection rates of pre-eclampsia, for a false positive rate of 5%, was 50% by uterine artery mean PI, 5% by PAPP-A, 10% by free beta-hCG, 35% by inhibin A and 44% by activin A. Screening by a combination of uterine artery mean PI and maternal serum activin A and inhibin A could detect 75% and 92% of patients who subsequently developed pre-eclampsia, for false positive rates of 5% and 10%, respectively. Screening for pre-eclampsia by uterine artery PI at 22 + 0 to 24 + 6 weeks' gestation can be improved by measurement of activin A and inhibin A levels.