title: Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension.
abstract: OBJECTIVE
  This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension.
  
  
  METHODS
  This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11-14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension.
  
  
  RESULTS
  Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP;P= 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN;P= 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI;P= 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P= 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%).
  
  
  CONCLUSIONS
  Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension.
authors.affiliation: Department of Obstetrics & Gynaecology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Pralhad
authors.initials: P
authors.lastname: Kushtagi
authors.affiliation: Department of Obstetrics & Gynaecology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Anoosha
authors.initials: A
authors.lastname: Emani
keywords: Doppler Ultrasonography; India; Pregnancy-Induced Hypertension; Pulse Pressure; Uterine Artery; Vascular Resistance