Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler

Abstract

Purpose To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE).

Materials and Methods We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE.

Results 40 (9.6 %) pregnant women developed PE. We observed significant differences in the body mass index (BMI) (p < 0.001), parity (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and pulsatility index (PI) of uterine artery Doppler (p < 0.001) between PE and control groups. The best model for the prediction of PE included maternal characteristics, MAP, maternal uterine and ophthalmic artery Doppler with area under receiver operating characteristics (ROC) curve of 0.710 (95 % confidence interval, 613 – 0.807) with a sensitivity of 45 % to a false-positive rate of 10 % and 35 % to a false-positive rate of 5 %.

Conclusion Maternal ophthalmic artery Doppler did not promote a significant increase in the PE detection rate during the second trimester scan.

Zusammenfassung

Ziel Bestimmung der Leistungsfähigkeit einer multiparametrischen Methode für die Vorhersage der Präeklampsie (PE) unter Einschluss von mütterlichen Risikofaktoren und der maternalen Doppleruntersuchung der A. uterina und A. ophthalmica im zweiten Schwangerschaftstrimenon.

Material und Methoden Wir führten eine prospektive Beobachtungs-Kohortenstudie an Schwangeren durch, bei denen ein Organ-Ultraschall im zweiten Trimenon durchgeführt wurde. Die maternalen Doppler-Untersuchungen von A. uterina und A. ophthalmica wurden in 415 Einlingsschwangerschaften in der 18. bis 23. Schwangerschaftswoche durchgeführt. Die zusätzliche klinische Anamnese wurde durch Patientenfragebögen erhoben, und eine Nachuntersuchung erfolgte nach der Entbindung zum Zeitpunkt der Entlassung. Die Kontroll- und die PE-Gruppe wurde durch den Kruskal-Wallis-Test für konstante Variablen und durch Chi-Square- und Fischers-Exakt-Teste für die kategorischen Variablen verglichen. Eine univariate und multivariate logistische Regressionsanalyse wurde durchgeführt, um das beste Modell für die Vorhersage einer PE zu ermitteln.

Ergebnisse Vierzig schwangere Frauen (9,6 %) entwickelten eine PE. Zwischen der PE- und der Kontrollgruppe beobachteten wir signifikante Unterschiede im Body-Mass-Index (BMI) (p < 0,001), der Parität (p < 0,001), dem mittleren arteriellen Druck (MAP) (p < 0,001) und dem Pulsatilitätsindex (PI) des Dopplers der A. uterina (p < 0,001). Das beste Modell für die Vorhersage einer PE schloss die mütterlichen Merkmale, den MAP und den maternalen Doppler mit einer Fläche unter der ROC-Kurve von 0,710 (95 % Konfidenzintervall: 613 – 0,807) und einer Sensitivität von 45 % bei einer Falsch-Positivrate von 10 % für die A. uterina und mit einer Sensitivität von 35 % bei einer Falsch-Positivrate von 5 % für die A. ophthalmica ein.

Schlussfolgerung Der maternale Doppler der A. ophthalmica hat nicht zu einer signifikanten Erhöhung der PE-Prädiktionsrate beim Zweittrimester-Ultraschall beigetragen.

Key words

preeclampsia - second trimester scan - uterine artery Doppler - maternal ophthalmic artery Doppler - maternal characteristics

• References

• 1 Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005; 365: 785-799
• 2 Onwudiwe N, Yu CK, Poon LC. et al. Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure. Ultrasound Obstet Gynecol 2008; 32: 877-883
• 3 Albaiges G, Missfelder-Lobos H, Lees C. et al. One-stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation. Obstet Gynecol 2000; 96: 559-564
• 4 Yu CK, Smith GC, Papageorghiou AT. et al. An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women. Am J Obstet Gynecol 2005; 193: 429-436
• 5 Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol 2010; 5: 173-192
• 6 Diniz AL, Moron AF, dos Santos MC. et al. Ophthalmic artery Doppler as a measure of severe pre-eclampsia. Int J Gynaecol Obstet 2008; 100: 216-220
• 7 Gurgel Alves JA, Praciano de Sousa PC, Bezerra Maia E. et al. First-trimester maternal ophthalmic artery Doppler analysis for prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2014; 44: 411-418
• 8 Brown MA, Lindheimer MD, de Swiet M. et al. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20: ix-xiv
• 9 Meads CA, Cnossen JS, Meher S. et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technol Assess 2008; 12: iii-iv
• 10 Endeshaw M, Abebe F, Bedimo M. et al. Diet and Pre-eclampsia: A Prospective Multicentre Case-Control Study in Ethiopia. Midwifery 2015; 31: 617-624
• 11 Victora CG, Aquino EM, do Carmo Leal M. et al. Maternal and child health in Brazil: progress and challenges. Lancet 2011; 377: 1863-1876
• 12 Leslie K, Thilaganathan B, Papageorghiou A. Early prediction and prevention of pre-eclampsia. Best Pract Res Clin Obstet Gynaecol 2011; 25: 343-354
• 13 Poon LC, Kametas NA, Maiz N. et al. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension 2009; 53: 812-818
• 14 Akolekar R, Syngelaki A, Sarquis R. et al. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31: 66-74
• 15 North RA, McCowan LM, Dekker GA. et al. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ 2011; 342: d1875
• 16 Thadhani R, Stampfer MJ, Hunter DJ. et al. High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstet Gynecol 1999; 94: 543-550
• 17 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14: 368-374
• 18 Plasencia W, Maiz N, Bonino S. et al. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 30: 742-749
• 19 Plasencia W, Maiz N, Poon L. et al. 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: 138-146
• 20 Cnossen JS, Morris RK, ter Riet G. 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: 701-711
• 21 Costa FS, Cunha SP, Berezowsky AT. Uterine artery doppler velocimetry for the prediction of complications in low-risk pregnancies. Rev Bras Ginecol Obstet 2005; 27: 323-330
• 22 Carneiro RS, Sass N, Diniz AL. et al. Ophthalmic artery Doppler velocimetry in healthy pregnancy. Int J Gynaecol Obstet 2008; 100: 211-215
• 23 Ohno Y, Kawai M, Wakahara Y. et al. Ophthalmic artery velocimetry in normotensive and preeclamptic women with or without photophobia. Obstet Gynecol 1999; 94: 361-363
• 24 Savvidou MD, Hingorani AD, Tsikas D. et al. Endothelial dysfunction and raised plasma concentrations of asymmetric dimethylarginine in pregnant women who subsequently develop pre-eclampsia. Lancet 2003; 361: 1511-1517
• 25 Ayaz T, Akansel G, Hayirlioglu A. et al. Ophthalmic artery color Doppler ultrasonography in mild-to-moderate preeclampsia. Eur J Radiol 2003; 46: 244-249
• 26 Hata T, Hata K, Moritake K. Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies and pregnancies complicated by hypertensive disorders. Am J Obstet Gynecol 1997; 177: 174-178
• 27 Bellamy L, Casas JP, Hingorani AD. et al. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335: 974