Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks.
OBJECTIVE
To examine the performance of screening for hypertensive disorders in pregnancy at 11-13 weeks by a combination of the maternal history, uterine artery Doppler imaging and blood pressure.


METHODS
This was a prospective screening study for pre-eclampsia (PE) requiring delivery before 34 weeks (early PE), late PE and gestational hypertension (GH) in women attending for their routine first hospital visit in pregnancy at 11 + 0 to 13 + 6 weeks of gestation. Maternal history was recorded, color flow Doppler imaging was used to identify the uterine artery with the lowest pulsatility index (L-PI) and automated devices were used to measure the mean arterial pressure (MAP). The performance of screening for PE and GH by a combination of the maternal factor-derived a-priori risk, the uterine artery L-PI and MAP was determined.


RESULTS
There were 8061 (96.4%) cases unaffected by PE or GH, 165 (2.0%) that developed PE including 37 that required delivery before 34 weeks (early PE) and 128 with late PE, and 140 (1.7%) that developed GH. The MAP was higher in early PE, late PE and GH than in the unaffected group (P < 0.0001), and in early PE than in GH (P = 0.002). The uterine artery L-PI was significantly higher in early PE and late PE than in the unaffected group (P < 0.0001), in early PE than late PE or GH (P < 0.0001), and in GH than in the unaffected group (P = 0.014). In screening by a combination of the maternal factor-derived a-priori risk, uterine artery L-PI and MAP, the estimated detection rate at a 10% false-positive rate was 89.2% (95% CI, 74.6-96.9%) for early PE, 57.0% (95% CI, 48.0-65.7%) for late PE and 50.0% (95% CI, 41.4-58.6%) for GH.


CONCLUSIONS
Effective screening for hypertensive disorders in pregnancy is provided by a combination of maternal history, uterine artery Doppler imaging and blood pressure at 11-13 weeks.
Poon
L C Y
LC
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Karagiannis
G
G
Leal
A
A
Romero
X C
XC
Nicolaides
K H
KH
D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology*; D018570:Risk Assessment / Q000379:methods; D014463:Ultrasonography; D006113:United Kingdom