title: First-trimester 3-dimensional power Doppler placental vascularization indices from the whole placenta versus the placental bed to predict preeclampsia: does pregnancy-associated plasma protein a or uterine artery Doppler sonography help?
abstract: OBJECTIVE
  The purpose of this study was to compare the use of vascular indices derived from the whole placenta to those from the placental bed only for predicting preeclampsia and to determine whether the addition of pregnancy-associated plasma protein A (PAPP-A) and mean uterine artery Doppler values improves prediction.
  
  
  METHODS
  We conducted a secondary analysis of a prospective cohort of women with singletons between 11 and 14 weeks' gestation undergoing sonography for aneuploidy screening. Placental vascularization indices from the whole placenta versus the placental bed were combined with first-trimester maternal serum PAPP-A levels, mean uterine artery Doppler values, or the combination of both to predict the development of preeclampsia or early preeclampsia (delivery <34 weeks). The predictive ability of each vascular index was calculated by using areas under receiver operating characteristic curves. The sensitivity of the model for predicting preeclampsia and early preeclampsia at fixed false-positive rates of 10% and 20% was calculated.
  
  
  RESULTS
  Of 570 women, 48 (8.4%) had preeclampsia, and 10 (1.7%) had early preeclampsia. The area under the curve and sensitivity values for the prediction of preeclampsia or early preeclampsia were not different when evaluating the whole placenta versus the placental bed. Additionally, there was no significant improvement when adding PAPP-A, uterine artery Doppler values, or both. The variables in the model were more sensitive for the prediction of early preeclampsia than preeclampsia.
  
  
  CONCLUSIONS
  Although placental bed vascular indices are modestly predictive of preeclampsia, the addition of PAPP-A and uterine artery Doppler values to vascularization indices in the whole placenta or the placental bed did not significantly improve their predictive ability.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA. hannafordk@wudosis.wustl.edu.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hannaford
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: Methodius
authors.initials: M
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Goetzinger
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Odibo
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: George
authors.initials: G
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri USA.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010920:Placenta / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000097:blood* / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A
keywords: 3-dimensional placental vascularization; first trimester; obstetric ultrasound; preeclampsia