Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry.
OBJECTIVE
To assess the performance of screening for preeclampsia and intrauterine growth restriction by combining second trimester maternal serum screening and uterine Doppler ultrasound.


METHODS
A cohort of 2,615 women underwent both maternal serum screening (using human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP)), and second trimester uterine artery Doppler. The sensitivity, specificity and predictive value of different combinations of both tests were compared.


RESULTS
The mean values for hCG and AFP were significantly higher in women with subsequent preeclampsia (p < 0.0003 and p < 0.03, respectively). Taking into account obstetrical history, hCG and AFP levels, notching on uterine artery Doppler and parity, the adjusted odds ratios were significantly higher for a high level of hCG for preeclampsia, intrauterine growth restriction (IUGR) and pregnancy-induced hypertension. AFP level >1.5 MoM (multiples of the median) was significantly correlated with subsequent IUGR. The presence of a uterine notch was associated with a significantly higher risk of both preeclampsia and IUGR. The combination of an elevated serum level and the presence of a uterine notch had a positive predictive value (PPV) for preeclampsia of 25 and 21% for hCG and AFP, respectively. The combination of a bilateral notch with a low level of hCG or a high level of AFP had a PPV for IUGR of 50 and 43%, respectively. The sensitivity of the different tests ranged from 2 to 40%.


CONCLUSIONS
The combination of serum markers and abnormal uterine Doppler ultrasound improves the identification of women at risk for subsequent pregnancy complications. These results should encourage care providers to perform a uterine Doppler ultrasound when serum markers are abnormal. However, the sensitivity of these tests is too low to provide an efficient generalized screening.
Audibert
François
F
Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique Hôpitaux de Paris et Université Paris XI, France. francois.audibert@umontreal.ca
Benchimol
Yehouda
Y
Benattar
Clarisse
C
Champagne
Catherine
C
Frydman
René
R
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D006801:Humans; D008403:Mass Screening / Q000592:standards; D011225:Pre-Eclampsia / Q000209:etiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood*; D012307:Risk Factors; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging*; D000509:alpha-Fetoproteins / Q000032:analysis*
D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins