Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre‐eclampsia

• Published in: Ultrasound in obstetrics & gynecology 2012-10, Vol.40 (4), p.406-411
• Main Authors: Belfort, M., Van Veen, T., White, G. L., Kofford, S., Allred, J., Postma, I., Varner, M.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Flow Velocity; Blood Pressure; Cardiovascular system; cerebrovascular resistance; Diseases of mother, fetus and pregnancy; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - physiopathology; Pre-Eclampsia - diagnostic imaging; Pre-Eclampsia - physiopathology; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy. Fetus. Placenta; pre‐eclampsia prediction; pulsatility index; resistance index; ROC Curve; Sensitivity and Specificity; transcranial ultrasound; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Vascular Resistance; Vasodilation
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.11078

Objective To determine if decreased resistance (vasodilatation) in the maternal middle cerebral artery (MCA) in the second trimester can predict third‐trimester development of pre‐eclampsia. Methods Four‐hundred and five low‐risk gravidas had MCA transcranial Doppler (TCD) once in the second trimester. Maternal/neonatal outcomes were evaluated after delivery. Mean blood pressure, MCA velocities, resistance index (RI), pulsatility index (PI) and cerebral perfusion pressure (CPP) were compared between normotensive and pre‐eclamptic cohorts. Results Seven subjects (1.7%) developed pre‐eclampsia. An RI of < 0.54 and a PI of < 0.81 were clinically useful in predicting subsequent pre‐eclampsia. Areas under the receiver–operating characteristics curves for RI and PI were 0.93 and 0.93, respectively, with optimal sensitivity and specificity of 86% and 93% for both variables. Positive and negative likelihood ratios were 11.8/0.15 (RI) and 12.3/0.15 (PI). Conclusion TCD indices of low maternal MCA resistance in the second trimester are predictive of the subsequent development of pre‐eclampsia in a low‐risk, ethnically homogeneous population. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.