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DOI: 10.1055/s-0041-1740273
Uterine Artery Pulsatility Index as a Pre-eclampsia Predictor in the 3 Trimesters in Women with Singleton Pregnancies
Índice de pulsatilidade da artéria uterina como preditor de pré-eclâmpsia nos 3 trimestres em mulheres com gestações únicas
Abstract
Objective To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women.
Methods The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram.
Results Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64–21.13; and OR: 10.32; 95%CI: 2.75–42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58–1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55–0.97) in the 3rd trimester was associated with late PE.
Conclusion Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE.
Resumo
Objetivo Avaliar o índice médio de pulsatilidade da artéria uterina (UtAPI) em cada trimestre da gravidez como preditor de pré-eclâmpsia (PE) precoce ou tardia em gestantes colombianas.
Métodos O UtAPI foi medido em gestações únicas em cada trimestre. O UtAPI como preditor de PE foi avaliado por odds ratio (OR), curvas receiver operating characteristic (ROC) e diagrama de Kaplan-Meier.
Resultados A análise no 1° e 3° trimestres mostrou que um UtAPI anormal foi associado com PE inicial (OR: 5,99; intervalo de confiança [IC] 95%: 1,64–21,13; OR: 10,32; IC95%: 2,75–42,49, respectivamente). A sensibilidade e a especificidade foram de 71,4 e 79,6%, respectivamente, para o desenvolvimento de PE (area under the curve [AUC]: 0,922). A curva de Kaplan-Meier mostrou que um UtAPI de 0,76 (IC95%: 0,58–1,0) no 1° trimestre foi associado com PE precoce, e que um UtAPI de 0,73 (IC95%: 0,55–0,97) no 3° trimestre foi associado com PE tardia.
Conclusão As artérias uterinas mostraram ser uma ferramenta preditora útil no 1° e 3° trimestres para PE inicial e no 3° trimestre para PE tardia em uma população de gestantes com alta prevalência de PE.
Contributors
All the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.
Publikationsverlauf
Eingereicht: 28. November 2020
Angenommen: 13. Oktober 2021
Artikel online veröffentlicht:
21. Dezember 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45 (06) 689-697 DOI: 10.1002/uog.14789.
- 2 Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333 DOI: 10.1016/S2214-109X(14)70227-X.
- 3 Guzmán-Yara YN, Parra-Amaya E, Javela-Rugeles JD, Barrios-Torres JC, Montalvo-Arce C, Perdomo-Sandoval HL. Expectant management in non-severe pre-eclampsia obstetric and perinatal outcomes in a high complexity hospital in Neiva (Colombia). Rev Colomb Obstet Ginecol 2018; 69 (03) 160-168 DOI: 10.18597/rcog.3075.
- 4 Wright D, Akolekar R, Syngelaki A, Poon LC, Nicolaides KH. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther 2012; 32 (03) 171-178 DOI: 10.1159/000338470.
- 5 Rolnik DL, Wright D, Poon LCY, Syngelaki A, O'Gorman N, de Paco Matallana C. et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 2017; 50 (04) 492-495 DOI: 10.1002/uog.18816.
- 6 Yücel B, Gedikbasi A, Dündar O, Olgac Y, Yɩldɩrɩm D, Yɩldɩrɩm G. et al. The utility of first trimester uterine artery Doppler, placental volume and PAPP-A levels alone and in combination to predict preeclampsia. Pregnancy Hypertens 2016; 6 (04) 269-273 DOI: 10.1016/j.preghy.2016.04.007.
- 7 O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M. et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49 (06) 756-760 DOI: 10.1002/uog.17455.
- 8 Gestational hypertension and preeclampsia. ACOG Practice Bulletin No. 222. Obstet Gynecol 2020; 135 (06) e237-e260 DOI: 10.1097/AOG.0000000000003891.
- 9 Mazhar K, Bhatti F, Maraj H. Pre-eclampsia. InnovAiT. 2014; 7 (01) 14-24 DOI: 10.1177/1755738013499318.
- 10 Orabona R, Donzelli CM, Falchetti M, Santoro A, Valcamonico A, Frusca T. Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47 (05) 580-585 DOI: 10.1002/uog.15799.
- 11 Valiño N, Giunta G, Gallo DM, Akolekar R, Nicolaides KH. Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2016; 47 (03) 308-315 DOI: 10.1002/uog.14898.
- 12 O'Gorman N, Tampakoudis G, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47 (05) 565-572 DOI: 10.1002/uog.15819.
- 13 Mula R, Meler E, Albaiges G, Rodriguez I. Strategies for the prediction of late preeclampsia. J Matern Fetal Neonatal Med 2019; 32 (22) 3729-3733 DOI: 10.1080/14767058.2018.1471592.
- 14 Andrietti S, Carlucci S, Wright A, Wright D, Nicolaides KH. Repeat measurements of uterine artery pulsatility index, mean arterial pressure and serum placental growth factor at 12, 22 and 32 weeks in prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2017; 50 (02) 221-227 DOI: 10.1002/uog.17403.
- 15 Cnossen JS, Morris RK, ter Riet G, Mol BWJ, van der Post JAM, Coomarasamy A. et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008; 178 (06) 701-711 DOI: 10.1503/cmaj.070430.
- 16 Poon LC, Karagiannis G, Leal A, Romero XC, Nicolaides KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34 (05) 497-502 DOI: 10.1002/uog.7439.
- 17 Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B. et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32 (02) 128-132 DOI: 10.1002/uog.5315.
- 18 Shwarzman P, Waintraub AY, Frieger M, Bashiri A, Mazor M, Hershkovitz R. Third-trimester abnormal uterine artery Doppler findings are associated with adverse pregnancy outcomes. J Ultrasound Med 2013; 32 (12) 2107-2113 DOI: 10.7863/ultra.32.12.2107.
- 19 Sibai BM. Management of late preterm and early-term pregnancies complicated by mild gestational hypertension/pre-eclampsia. Semin Perinatol 2011; 35 (05) 292-296 DOI: 10.1053/j.semperi.2011.05.010.
- 20 Romero XC, Gutiérrez AM, Rojas NA, Ramírez A, Aldana J, Eslava M. et al. Incidencia de los trastornos hipertensivos en el embarazo, y características clínico-demográficas en tres instituciones en Bogotá, D.C., Colombia. Investig Segur Soc Salud. 2018; 20 (02) 21-30
- 21 Organización Panamericana de la Salud. Indicadores de salud: aspectos conceptuales y operativos [Internet]. Washington (DC): OPS; 2018. [cited 2020 Jul 12]. Available from: https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/indicadores-de-salud-boletines/4072-indicadores-de-salud-aspectos-conceptuales-y-operativos-2018/file
- 22 Khalil A, Nicolaides KH. How to record uterine artery Doppler in the first trimester. Ultrasound Obstet Gynecol 2013; 42 (04) 478-479 DOI: 10.1002/uog.12366.
- 23 Bhide A, Acharya G, Bilardo CM, Brezinka C Cafici D, Hernandez-Andrade E. et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013; 41 (02) 233-239 DOI: 10.1002/uog.12371.
- 24 Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2008; 32 (02) 138-146 DOI: 10.1002/uog.5402.
- 25 Bibbins-Domingo K, Grossman DC, Curry SJ, Curry SJ, Barry MJ, Davidson KW. et al; US Preventive Services Task Force. Screening for Preeclampsia: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 317 (16) 1661-1667 DOI: 10.1001/jama.2017.3439.
- 26 Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists; 2013
- 27 Henderson JT, Thompson JH, Burda BU, Cantor A. Preeclampsia screening: evidence report and systematic review for the US Preventive Services Task Force. JAMA 2017; 317 (16) 1668-1683 DOI: 10.1001/jama.2016.18315.
- 28 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50 DOI: 10.1097/AOG.0000000000003020.
- 29 World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects [Internet]. 2018 [cited 2020 Jan 23]. Available from: https://www.wma.net/polices-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
- 30 Uriel M, Romero XC. Reality of preeclampsia in Colombian pregnant women. Open Access J Gynecol. 2016; 1 (01) 000105
- 31 Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170 (01) 1-7 DOI: 10.1016/j.ejogrb.2013.05.005.
- 32 Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: pathophysiology, challenges, and perspectives. Circ Res 2019; 124 (07) 1094-1112 DOI: 10.1161/CIRCRESAHA.118.313276.
- 33 Jamal A, Abbasalizadeh F, Vafaei H, Marsoosi V, Eslamian L. Multicenter screening for adverse pregnancy outcomes by uterine artery Doppler in the second and third trimester of pregnancy. Med Ultrason 2013; 15 (02) 95-100 DOI: 10.11152/mu.2013.2066.152.aj1fa2.
- 34 Arrue M, García M, Rodriguez-Bengoa MT, Landa JM, Urbieta L, Maitzegui M. et al. Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes. J Matern Fetal Neonatal Med 2017; 30 (07) 877-880 DOI: 10.1080/14767058.2016.1190822.
- 35 Takahashi K, Ohkuchi A, Suzuki H, Usui R, Kuwata T, Shirasuna K. et al. Biophysical interaction between blood pressure and uterine artery Doppler for the occurrence of early-onset preeclampsia: A prospective cohort study. Pregnancy Hypertens 2013; 3 (04) 270-277 DOI: 10.1016/j.preghy.2013.07.006.