Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure.
OBJECTIVE
To determine the value of combined screening for pre-eclampsia by maternal history, and mid-trimester uterine artery (UtA) Doppler imaging and maternal blood pressure.


METHODS
In 3529 singleton pregnancies attending for routine care at 22-24 weeks' gestation we recorded maternal variables, and made UtA Doppler and mean arterial pressure (MAP) measurements. Multiple regression analysis was used to determine the significant predictors of pre-eclampsia, gestational hypertension and small-for-gestational age (SGA) among maternal characteristics, UtA pulsatility index (PI) and MAP.


RESULTS
Complete pregnancy outcomes were available in 3359/3529 (95.2%) cases. Pre-eclampsia developed in 101 (3.0%) pregnancies, including 23 (0.7%) in which delivery was before 34 weeks (early pre-eclampsia) and 78 (2.3%) with delivery at 34 weeks or more (late pre-eclampsia); 74 (2.2%) developed gestational hypertension, 366 (10.9%) delivered SGA newborns with no hypertensive disorders, and 2806 (83.8%) were unaffected by pre-eclampsia, gestational hypertension or SGA. Multiple regression analysis demonstrated that maternal characteristics, UtA-PI and MAP provided a significant independent contribution in the prediction of pre-eclampsia, gestational hypertension and SGA. For a false-positive rate of 10%, the estimated detection rates of early and late pre-eclampsia were 100% and 56.4%, respectively.


CONCLUSIONS
The combination of maternal demographic characteristics, and UtA Doppler and maternal blood pressure measurements is an effective screening tool for the prediction of pre-eclampsia.
Onwudiwe
N
N
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK.
Yu
C K H
CK
Poon
L C Y
LC
Spiliopoulos
I
I
Nicolaides
K H
KH
D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods; D014599:Uterus / Q000098:blood supply*; D055815:Young Adult