title: The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population.
abstract: OBJECTIVE
  The underlying pathophysiology of preeclampsia is thought to be abnormal trophoblast invasion of the spiral arteries leading to maldevelopment of uteroplacental perfusion. We estimated whether uterine artery Doppler measurements made in the early second trimester would predict the subsequent development of preeclampsia.
  
  
  METHODS
  Uterine artery Doppler measurements before 21 weeks of gestation (median 16.6 weeks) were correlated with subsequent development of preeclampsia in a cohort of 2,188 low-risk nulliparous women in a randomized control trial of antioxidant supplementation for prevention of preeclampsia. Preeclampsia developed in 165 (7.5%) women.
  
  
  RESULTS
  Development of preeclampsia overall was associated with increased resistance index, pulsatility index, a pulsatility index or resistance index multiple of the median at or above the 75th percentile but not the presence of a notch or a bilateral notch before 21 weeks of gestation. The sensitivity was 43% (95% confidence interval [CI] 35-51) and specificity 67% (95% CI 65-69) for prediction of preeclampsia overall. The presence of a notch or bilateral notch, resistance index, and pulsatility index multiple of the median was significantly associated with early onset (before 34 weeks of gestation) compared with late onset or no preeclampsia (odds ratio [OR] 6.9, 95% CI 2.3-20.9; sensitivity 78%, 95% CI 52-94; specificity 66%, 95% CI 64-68). The presence of a notch or resistance index multiple of the median at or above the 75th percentile increased the odds of developing severe compared with mild or no preeclampsia (OR 2.2, 95% CI 1.4-3.7; sensitivity 53%, 95% CI 40-65; specificity 66%, 95% CI 64-68).
  
  
  CONCLUSIONS
  Our data show poor sensitivity of second-trimester Doppler ultrasound measurements for prediction of preeclampsia overall in a well-characterized, low-risk, nulliparous population. The technique has utility in identifying poor trophoblast invasion of spiral arteries of a magnitude that severely compromises uteroplacental blood flow and gives early-onset disease.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics, University of Cincinnati, Cincinnati, Ohio, USA. Myattl@uthscsa.edu
authors.forename: Leslie
authors.initials: L
authors.lastname: Myatt
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Clifton
authors.forename: James M
authors.initials: JM
authors.lastname: Roberts
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: John C
authors.initials: JC
authors.lastname: Hauth
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Marshall W
authors.initials: MW
authors.lastname: Carpenter
authors.forename: Philip
authors.initials: P
authors.lastname: Samuels
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Garland D
authors.initials: GD
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D015331:Cohort Studies; D005260:Female; D018056:Hemorheology; D006801:Humans; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D012306:Risk; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology