Maternal uterine artery Doppler in the first and second trimesters as screening method for hypertensive disorders and adverse perinatal outcomes in low-risk pregnancies.
OBJECTIVE
To assess the maternal demographic characteristics and uterine artery (UA) Doppler parameters at first and second trimesters of pregnancy as predictors for hypertensive disorders (HDs) and adverse perinatal outcomes.


METHODS
This prospective cohort study comprised 162 singleton low-risk women undergoing routine antenatal care. The left and right UA were assessed by color and pulsed Doppler and the mean pulsatility and resistance indices as well as the presence of a bilateral protodiastolic notch were recorded at 11 to 14 and 20 to 24 weeks' gestation. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal UA Doppler parameters on the incidence of HD, small for gestational age newborn, cesarean section rate, Apgar score <7 at 1st and 5th minute, and admission to the neonatal intensive care unit.


RESULTS
Fifteen women (9.2%) developed HD. UA mean resistance index (RI), UA mean pulsatility index, and parity were independent predictors of HD. Compared to the pregnancies with a normal UA mean RI at the first and second trimesters, pregnancies with UA mean RI >95th percentile only at the first trimester showed an increased risk for HD (odds ratio, 23.25; 95% confidence interval, 3.47 to 155.73; P<0.01). Similar result was found for UA mean pulsatility index >95th percentile (odds ratio, 9.84; 95% confidence interval, 1.05 to 92.10; P=0.05). The model including maternal age, maternal and paternal ethnicity, occupation, parity and UA mean RI increased the relative risk for HD (area under receiver operating characteristics, 0.81).


CONCLUSIONS
A first-trimester screening combining maternal characteristics and UA Doppler parameters is useful to predict HD in a low-risk population.
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Rosiane Maciel
RM
Scandiuzzi
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Caio Antonio de Campos
CA
Prado
Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
Edward
0000-0002-6145-2532
E
Araujo Júnior
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Geraldo
G
Duarte
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Silvana Maria
SM
Quintana
Department of Perinatal Medicine, Royal Women's Hospital, Melbourne, Australia.; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.
Fabrício
F
da Silva Costa
Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.
Gabriele
G
Tonni
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Ricardo de Carvalho
Rde C
Cavalli
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto-SP, Brazil.
Alessandra Cristina
AC
Marcolin
Doppler ultrasonography; First trimester of pregnancy; Pregnancy-induced hypertension; Second trimester of pregnancy; Uterine artery
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