Uterine artery Doppler change in the second trimester associated with risk of preeclampsia

Uterine artery Doppler change in the second trimester associated with risk of preeclampsia

Preeclampsia (PE) and eclampsia are obstetric morbidities with an estimated prevalence of 2% to 8% and are responsible for 10% to 15% of maternal mortality. The pathogenesis of PE involves inadequate placentation associated with impaired trophoblastic invasion.

Doppler ultrasound study of the uterine artery allows a non-invasive assessment of placental vascular function by obtaining resistance (RI) and pulsatility (PI) indices and observation of the protodiastolic notch, allowing the prediction and diagnosis of obstetric morbidities. However, there is no consensus on the magnitude of the assessment of uterine artery Dopplervelocimetric indices in the prediction of preeclampsia.

Read too: Combination of Doppler and amniotic fluid assessment to predict adverse perinatal outcomes in intrauterine growth restriction

Recent analysis of the risk of preeclampsia

So a Chinese article recently published in International Journal of Gynecology and Obstetrics aimed to estimate the normal range of uterine artery Doppler indices from 21 to 23 weeks and the correlation of their abnormalities with risk of preeclampsia.

Data from 8,750 live births from 2017 to 2019 were analyzed. Prenatal, ultrasound and delivery data were obtained. Among these cases, 447 (5%) were diagnosed with PE.

Data for uterine artery Doppler evaluation were: pulsatility index (PI), resistance index (RI) and presence of protodiastolic notch. Indices greater than 95% were considered altered. To study the association with PE, logistic regression models were created.

Findings and Conclusion

The study constructed a normality table for uterine artery RI and PI at gestational ages of 21, 22, and 23 weeks, from data from pregnancies without morbidity, and established percentiles of normality.

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Compared with normal results, unilateral PI > p95 (OR=2.3, 95%CI: 1.71-3.10), bilateral PI > p95 (OR=6.21, 95%CI: 3.53-10.95 ), unilateral IR > p95 (OR =2.36, 95% CI: 1.75 – 3.17), bilateral IR > p85 (OR =2.83, 95% CI: 1.27 – 6.32), protodiastolic notch unilateral (OR=3.66, 95%CI: 2.03 – 6.62) and bilateral (OR=5.80, 95%CI: 3.30 – 10.20) were associated with PE. For every 0.1 increase in the median multiple of the mean PI, the risk of PE increased by 13%, while the same increase in RI increased the risk of PE by 22%.

The conclusion of the article is in agreement with other previously published works, that altered values ​​of uterine artery Dopplervelocimetric indices obtained in the second trimester are associated with the development of PE, together with the finding of a protodiastolic notch. Bilateral findings, altered right and left uterine arteries, have a better prediction and a good tool is the evaluation through multiples of the median of these indices.

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#Uterine #artery #Doppler #change #trimester #risk #preeclampsia

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