Abstract
Objective
To compare the efficacy of uterine artery Doppler velocimetry and three-dimensional
ultrasound placental volume calculation alone or in combination in predicting at 11–14
weeks of gestation those pregnancies who will develop pre-eclampsia.
Study design
This was a prospective study of 348 nulliparous women scheduled for a routine prenatal
ultrasound examination at 11–14 weeks. Color and pulsed wave Doppler was used to obtain
uterine artery flow velocity waveforms transabdominally and the mean pulsatility index
(PI) of the uterine arteries was calculated. The placental volume was measured by
three-dimensional ultrasound using the virtual organ computer-aided analysis. Outcome
variables considered were pre-eclampsia and pre-eclampsia requiring delivery <32 weeks.
Results
Pre-eclampsia developed in 4.1% of the patients studied and in 1.7% a delivery before
32 weeks was required. Placental volume resulted significantly lower in pregnancies
who will develop pre-eclampsia (t = 4.636, p < 0.003) and this was particularly evident in those pregnancies delivering <32 weeks
(t = 9.704, p < 0.0002). No relationship was found between placental volume and mean uterine artery
PI (r = −0.08, p = 0.327). Uterine artery PI and placental volume showed similar sensitivities in predicting
pre-eclampsia (50% vs. 56%) and pre-eclampsia with delivery <32 weeks (66.7% vs. 66.7%).
The combination of uterine artery PI and placental volume gave better results when
compared to the single use of one of these parameters (pre-eclampsia sensitivity 68.7%,
pre-eclampsia requiring delivery <32 weeks 83.3%).
Conclusions
The combination of abnormal uterine artery Doppler and low placental volume at 11–14
weeks achieves better results than does either test alone in the prediction of pre-eclampsia.
Keywords
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References
- An ultrastructural study of utero-placental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation.Br J Obstet Gynaecol. 1981; 88: 695-705
- Placental bed spiral arteries in the hypertensive disorders of pregnancy.Br J Obstet Gynaecol. 1991; 98: 648-655
- Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre-eclampsia, placental abruption or delivery of a small-for-gestational-age baby.Ultrasound Obstet Gynecol. 1996; 7: 182-188
- Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation.Ultrasound Obstet Gynecol. 2001; 18: 441-449
- First-trimester screening for pre-eclampsia.Ultrasound Obstet Gynecol. 2005; 26: 487-489
- Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches.BJOG. 2002; 109: 161-167
- Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11–14 weeks of gestation.Ultrasound Obstet Gynecol. 2001; 18: 583-586
- Screening test for pre-eclampsia through assessment of uteroplacental blood flow and biochemical markers of oxidative stress and endothelial dysfunction.Am J Obstet Gynecol. 2005; 193: 1486-1491
- Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population.Ultrasound Obstet Gynecol. 2005; 26: 490-494
- Placental volume measured by three-dimensional ultrasound at 11 to 13 + 6 weeks of gestation: relation to chromosomal defects.Ultrasound Obstet Gynecol. 2005; 26: 28-32
- Correlation of first trimester placental volume and second trimester uterine artery Doppler flow.Placenta. 2001; 22: 729-734
- Comparison between three-dimensional placental volume at 12 weeks and uterine artery impedance/notching at 22 weeks in screening for pregnancy-induced hypertension, pre-eclampsia and fetal growth restriction in a low-risk population.Ultrasound Obstet Gynecol. 2006; 27: 652-657
- The classification and definition of the hypertensive disorders of pregnancy.Am J Obstet Gynecol. 1988; 158: 892-898
- Uteroplacental blood flow velocity waveforms as predictors of pregnancy-induced hypertension.Eur J Obstet Gynecol Reprod Biol. 1987; 26: 335-341
- Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia.Placenta. 2000; 21: S25-S30
- Uterine artery Doppler and placental volume in the first trimester in the prediction of pregnancy complications.Ultrasound Obstet Gynecol. 2001; 18: 590-592
- Heterogeneous causes constituting the single syndrome of preeclampsia: a hypothesis and its implications.Am J Obstet Gynecol. 1996; 175: 1365-1370
- Soluble vascular endothelial factor receptor-1 (sFlt-1) is increased through gestation in patients who have pre-eclampsia develop.Am J Obstet Gynecol. 2004; 191: 1240-1246
Article info
Publication history
Published online: September 20, 2007
Accepted:
August 22,
2007
Received in revised form:
June 20,
2007
Received:
February 4,
2007
Identification
Copyright
© 2007 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
