title: Adverse fetal outcome: is first trimester ultrasound and Doppler better predictor than biomarkers?
abstract: OBJECTIVE
  To evaluate the predictive value of first trimester biomarkers and ultrasound in determining adverse fetal outcomes in a low risk Asian population.
  
  
  METHODS
  All low risk, singleton pregnancies between 11 and 14 weeks gestation underwent ultrasound with uterine artery Doppler along with PAPP-A and free β-hCG estimation, and were followed till delivery to observe the outcome. The adverse fetal outcomes detected were structural anomaly, aneuploidy, intrauterine growth restriction, preterm birth and stillbirth (SB).
  
  
  RESULTS
  Out of 3500 women screened, 417 cases had adverse fetal outcome in the absence of maternal complication, 2151 had normal outcome. Major structural anomaly was detected in first trimester in 17/28 (60.7%) cases. The most important markers for adverse fetal outcome were increased uterine artery pulsatility index (UPI) (p = 0.028, OR 1.5, 95% CI: 1.05-2.38, AUC 0.56) for IUGR, nuchal translucency (p = 0.001, OR 1.7, 95% CI: 1.11-2.77, AUC 0.60) for major anomaly and low PAPP-A (p = 0.017, OR -0.075, 95% CI: 0.87-0.98, AUC 0.621) for SB.
  
  
  CONCLUSIONS
  UPI, NT and PAPP-A in the first trimester are significant markers of adverse fetal outcome, although the sensitivity and specificity are not high they have a high negative predictive value.
authors.affiliation: a Obstetrics & Gynecology, LHMC , New Delhi , India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Kumar
authors.affiliation: b ICMR , New Delhi , India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
authors.affiliation: c LHMC , New Delhi , India.
authors.forename: Karuna
authors.initials: K
authors.lastname: Sharma
authors.affiliation: d Department of Biochemistry , LHMC , New Delhi , India , and.
authors.forename: Ritu
authors.initials: R
authors.lastname: Singh
authors.affiliation: e Lady Sri Ram College , New Delhi , India.
authors.forename: V
authors.initials: V
authors.lastname: Ravi
authors.affiliation: d Department of Biochemistry , LHMC , New Delhi , India , and.
authors.forename: J
authors.initials: J
authors.lastname: Bhattacharya
mesh_terms: D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis; D018568:Crown-Rump Length; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D006801:Humans; D048208:Nuchal Translucency Measurement; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011261:Pregnancy Trimester, First / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000175:diagnosis; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A
keywords: IUGR; Ultrasound; fetal outcome; first trimester; uterine artery Doppler