title: Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia.
abstract: OBJECTIVE
  To evaluate the performance of models described previously for the prediction of pre-eclampsia (PE), based on the sequential evaluation of uterine artery resistance at 11-13 weeks and 19-22 weeks, in a high-risk population.
  
  
  METHODS
  This was a prospective study in 135 women with singleton pregnancies and at least one of the following high-risk conditions: PE and/or intrauterine growth restriction in a previous pregnancy, chronic hypertension, pregestational diabetes, renal disease, body mass index > 30 kg/m(2) , autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome or rheumatoid arthritis) and thrombophilia. Mean uterine artery pulsatility index (mUtA-PI) at 11-13 and at 19-22 weeks' gestation was measured and analyzed according to quantitative and semi-quantitative models, to predict late PE (resulting in delivery ≥ 34 weeks) and early PE (delivery < 34 weeks).
  
  
  RESULTS
  Late PE developed in 21 (15.6%) pregnancies and early PE in six (4.4%). Using mUtA-PI, the detection rates of late and early PE for a false-positive rate of 10% were 14.3% and 33.3%, respectively, at 11-13 weeks, and 19.0% and 66.7%, respectively, at 19-22 weeks. Using a semi-quantitative approach, the group of pregnant women with mUtA-PI ≥ 90(th) percentile at both 11-13 and 19-22 weeks had a greater risk for early PE (odds ratio, 21.4 (95% CI, 2.5-184.7)) compared with the group with mUtA-PI < 90(th) percentile at both periods. Using a quantitative approach, there was relative worsening in the mUtA-PI (multiples of the median) from the first to the second trimester in all cases of early PE.
  
  
  CONCLUSIONS
  The application of semi-quantitative and especially quantitative models to evaluate sequential changes in uterine artery Doppler findings between the first and second trimesters could be of additional value in assessing high-risk women regarding their true risk of developing early PE.
authors.affiliation: Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Herraiz
authors.forename: D
authors.initials: D
authors.lastname: Escribano
authors.forename: P I
authors.initials: PI
authors.lastname: Gómez-Arriaga
authors.forename: J M
authors.initials: JM
authors.lastname: Herníndez-García
authors.forename: M A
authors.initials: MA
authors.lastname: Herraiz
authors.forename: A
authors.initials: A
authors.lastname: Galindo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015233:Models, Statistical; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D011673:Pulsatile Flow; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014655:Vascular Resistance