First-trimester uterine artery Doppler indices in term and preterm pre-eclampsia.
OBJECTIVE
To assess the relationship between first-trimester uterine artery Doppler measurements and the development of term and preterm pre-eclampsia.


METHODS
This prospective study of uterine artery Doppler findings at 11-14 weeks in 3058 singleton pregnancies included 57 and 33 cases of term and preterm pre-eclampsia, respectively.


RESULTS
The first-trimester uterine artery resistance index (RI) was significantly higher in women who subsequently developed preterm pre-eclampsia (mean RI, 0.79) than in those with a normal outcome (mean RI, 0.70; P = 0.0001) or those who developed pre-eclampsia at term (mean RI, 0.72; P = 0.002). There were no significant differences in first-trimester mean uterine artery RI (P = 0.136) or prevalence of bilateral notches (P = 0.459) between women who had a normal pregnancy outcome and those who developed pre-eclampsia at term. The receiver-operating characteristics curves for the prediction of term and preterm pre-eclampsia by uterine artery Doppler imaging demonstrated a significant association with development of preterm pre-eclampsia (P = 0.0001; area under the curve (AUC), 0.76; 95% CI, 0.66-0.86) but not term pre-eclampsia (P = 0.25; AUC, 0.54; 95% CI, 0.46-0.63).


CONCLUSIONS
The uterine artery Doppler data in this study suggest that preterm pre-eclampsia is strongly associated with defective invasion of the spiral arteries, in contrast to the findings in term pre-eclampsia which may be a consequence of placental deterioration at term. Our study findings support, but do not prove, a rigid separation between the etiology of early- and late-onset pre-eclampsia. Although there is a strong relationship between first-trimester uterine artery Doppler indices and the subsequent development of preterm pre-eclampsia, our data do not support its routine introduction into clinical practice.
Melchiorre
K
K
Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK.
Wormald
B
B
Leslie
K
K
Bhide
A
A
Thilaganathan
B
B
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014599:Uterus / Q000098:blood supply*