Role of routine uterine artery Doppler at 18–22 and 24–28 weeks' gestation following routine first‐trimester screening for pre‐eclampsia

• Published in: Ultrasound in obstetrics & gynecology 2025-01, Vol.65 (1), p.63-70
• Main Authors: Bonacina, E., Del Barco, E., Farràs, A., Dalmau, M., Garcia, E., Gleeson‐Vallbona, L., Serrano, B., Armengol‐Alsina, M., Catalan, S., Hernadez, A., San José, M., Miserachs, M., Millan, P., Garcia‐Manau, P., Carreras, E., Mendoza, M.
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Eclampsia; Female; first trimester; Gestation; Gestational Age; Gynecology; Humans; Infant, Newborn; Infant, Small for Gestational Age; Likelihood ratio; Observational studies; Obstetrics; Original Paper; Performance assessment; Pre-Eclampsia - diagnosis; Pre-Eclampsia - diagnostic imaging; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, First; pre‐eclampsia; Pulsatile Flow; Retrospective Studies; ROC Curve; screening; Sensitivity and Specificity; Subgroups; Ultrasonic imaging; Ultrasonography, Doppler; Ultrasonography, Prenatal; Ultrasound; Uterine Artery - diagnostic imaging; Uterine Artery - physiopathology; uterine artery Doppler; Uterus
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.29145

ABSTRACT Objectives To assess the performance of mean uterine artery pulsatility index (UtA‐PI) at 18–22 and 24–28 weeks of gestation in the prediction of pre‐eclampsia (PE) and small‐for‐gestational age (SGA), and its role in reassessing the risk of PE and SGA in pregnancies screened for PE in the first trimester. Methods This was a retrospective observational cohort study of 4464 women with singleton pregnancy screened routinely for PE in the first trimester, using the Gaussian algorithm, from March 2019 to May 2021, and who underwent UtA‐PI assessment at 18–22 gestational weeks. Women were categorized as low risk or high risk based on the risk index obtained after first‐trimester screening for PE. In high‐risk patients, UtA‐PI was also assessed at 24–28 weeks of gestation. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and area under the receiver‐operating‐characteristics curve were calculated to assess the performance of UtA‐PI at 18–22 and 24–28 weeks in predicting PE and SGA in the high‐risk group. In all participants, different UtA‐PI percentiles at 18–22 or 24–28 weeks, or their combination, were analyzed to explore their role in reassessing the risk of PE and SGA following first‐trimester PE screening. Results The performance of UtA‐PI at 18–22 and 24–28 weeks in the high‐risk group was good for predicting preterm PE and preterm SGA, and excellent for predicting early‐onset PE and early‐onset SGA, with an NPV of > 97% for all outcomes. In the low‐risk group, UtA‐PI ≥ 95th percentile at 18–22 weeks' gestation identified a subgroup of pregnancies with a significantly higher risk of preterm SGA compared to the low‐risk group. In the high‐risk group, UtA‐PI