Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11–14 weeks' gestation

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Abstract

Objective

To assess the role of maternal demographic characteristics, uterine artery Doppler velocimetry, maternal serum pregnancy-associated plasma protein-A (PAPP-A) and their combination in screening for pre-eclampsia and small-for-gestational age (SGA) fetuses at 11–14 weeks.

Methods

This was a prospective study of 878 consecutive women presenting for a routine prenatal ultrasound examination at 11–14 weeks. Pulsed wave Doppler was then used to obtain uterine artery flow velocity waveforms and the mean pulsatility index (PI) of the uterine arteries was calculated. Maternal serum samples for PAPP-A were assayed. Along with maternal history, these measurements were compared in their ability to predict adverse outcome, defined as pre-eclampsia and/or SGA and/or placental abruption.

Results

Mean uterine artery PI ≥ 95th centile and PAPP-A ≤ 10th centile each predicted 23% of the women that developed pre-eclampsia and 43% of cases of placental abruption. For SGA ≤ 5th centile, mean uterine artery PI ≥ 95th centile predicted 23% of cases and PAPP-A ≤ 10th centile predicted 34%. Independent predictors for subsequent development of pre-eclampsia were increased mean uterine artery PI ≥ 95th centile (OR, 2.76; 95% CI, 1.11–6.81) and maternal history of pre-eclampsia/hypertension (OR, 50.54; 95% CI, 10.52–242.73). The predicting factors for SGA ≤ 5th centile were increased mean uterine artery PI ≥ 95th centile (OR, 2.0; 95% CI, 1.07–3.74) and low PAPP-A (OR, 0.43; 95% CI, 0.20–0.93). Increased uterine artery PI was the only independent factor in the prediction of placental abruption (OR, 8.49; 95% CI, 2.78–25.94). The combination of uterine artery PI and maternal history of pre-eclampsia/hypertension was better than was using uterine artery Doppler alone in predicting pre-eclampsia. Similarly, for the prediction of SGA ≤ 5th centile, combining uterine artery Doppler and maternal serum PAPP-A was better than was uterine artery Doppler alone. In both cases, the difference approached statistical significance.

Conclusions

The combination of maternal history with abnormal uterine artery Doppler and low PAPP-A level at 11–14 weeks achieves better results than does either test alone in the prediction of pre-eclampsia and SGA. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

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