Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler.
OBJECTIVE
To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE).


METHODS
We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE.


RESULTS
40 (9.6 %) pregnant women developed PE. We observed significant differences in the body mass index (BMI) (p < 0.001), parity (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and pulsatility index (PI) of uterine artery Doppler (p < 0.001) between PE and control groups. The best model for the prediction of PE included maternal characteristics, MAP, maternal uterine and ophthalmic artery Doppler with area under receiver operating characteristics (ROC) curve of 0.710 (95 % confidence interval, 613 - 0.807) with a sensitivity of 45 % to a false-positive rate of 10 % and 35 % to a false-positive rate of 5 %.


CONCLUSIONS
Maternal ophthalmic artery Doppler did not promote a significant increase in the PE detection rate during the second trimester scan.
Public Health, State University of Ceará (UECE), Fortaleza, Brazil.
Paulo César
PC
Praciano de Souza
Public Health, State University of Ceará (UECE), Fortaleza, Brazil.
Júlio Augusto
JA
Gurgel Alves
Public Health, State University of Ceará (UECE), Fortaleza, Brazil.
Sammya
S
Bezerra Maia E Holanda Moura
Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Edward
E
Araujo Júnior
Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto, Brazil.
Wellington P
WP
Martins
Obstetrics and Gynaecology, University of Melbourne, Australia.
Fabricio
F
Da Silva Costa
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009880:Ophthalmic Artery; D011225:Pre-Eclampsia; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011673:Pulsatile Flow; D012372:ROC Curve; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging; D014599:Uterus