The utility of uterine artery doppler velocimetry in prediction of preeclampsia in a low-risk population

Authors

Leslie Myatt, University of Texas Health Science Center at San Antonio
Rebecca G. Clifton, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
James M. Roberts, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Catherine Y. Spong, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
John C. Hauth, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Michael W. Varner, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Ronald J. Wapner, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
John M. Thorp, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Brian M. Mercer, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
William A. Grobman, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Susan M. Ramin, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Marshall W. Carpenter, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Philip Samuels, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Anthony Sciscione, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Margaret Harper, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Jorge E. Tolosa, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
George Saade, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Yoram Sorokin, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda
Garland D. Anderson, TX USA BU Providence RI USA OHSUC OH USA Drexel Univ. Philadelphia PA USA WFUHS Winston-Salem N. Carolina USA OHSU Portland OR USA UTM. Br. Galveston TX USA WSU. Detroit MI USA GWU Biostatist. Ctr. WA DC USA Eunice Kennedy Shriver NICHHD Bethesda

Document Type

Journal Article

Publication Date

10-1-2012

Journal

Obstetrics and Gynecology

Volume

120

Issue

4

DOI

10.1097/AOG.0b013e31826af7fb

Abstract

OBJECTIVE: The underlying pathophysiology of preeclampsia is thought to be abnormal trophoblast invasion of the spiral arteries leading to maldevelopment of uteroplacental perfusion. We estimated whether uterine artery Doppler measurements made in the early second trimester would predict the subsequent development of preeclampsia. METHODS: Uterine artery Doppler measurements before 21 weeks of gestation (median 16.6 weeks) were correlated with subsequent development of preeclampsia in a cohort of 2,188 low-risk nulliparous women in a randomized control trial of antioxidant supplementation for prevention of preeclampsia. Preeclampsia developed in 165 (7.5%) women. RESULTS: Development of preeclampsia overall was associated with increased resistance index, pulsatility index, a pulsatility index or resistance index multiple of the median at or above the 75th percentile but not the presence of a notch or a bilateral notch before 21 weeks of gestation. The sensitivity was 43% (95% confidence interval [CI] 35-51) and specificity 67% (95% CI 65-69) for prediction of preeclampsia overall. The presence of a notch or bilateral notch, resistance index, and pulsatility index multiple of the median was significantly associated with early onset (before 34 weeks of gestation) compared with late onset or no preeclampsia (odds ratio [OR] 6.9, 95% CI 2.3-20.9; sensitivity 78%, 95% CI 52-94; specificity 66%, 95% CI 64-68). The presence of a notch or resistance index multiple of the median at or above the 75th percentile increased the odds of developing severe compared with mild or no preeclampsia (OR 2.2, 95% CI 1.4-3.7; sensitivity 53%, 95% CI 40-65; specificity 66%, 95% CI 64-68). CONCLUSION: Our data show poor sensitivity of second-trimester Doppler ultrasound measurements for prediction of preeclampsia overall in a well-characterized, low-risk, nulliparous population. The technique has utility in identifying poor trophoblast invasion of spiral arteries of a magnitude that severely compromises uteroplacental blood flow and gives early-onset disease. © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.

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